AB109. SOH25_AB_094. Dual surgeon, dual incision approach to distal femoral soft tissue sarcoma

Background: Soft tissue sarcomas account for 1% of all cancers, with the majority occurring in the lower limb. Sarcomas located in the distal posterior thigh and proximal popliteal fossa present significant surgical challenges due to the proximity of critical structures such as the femoral vessels and sciatic nerve. These cases often necessitate amputation rather than limb salvage surgery.

Methods: We analysed the outcomes of eight patients undergoing surgery for soft tissue sarcoma of the distal femur posterior compartment following neo-adjuvant radiotherapy. Preoperative imaging was reviewed by two sarcoma surgeons to assess the relationship between the tumour and neurovascular structures. All patients were consented for dual incision surgery and the possibility of an above-knee amputation.

Results: In all eight cases, both consultant surgeons participated in the procedure. A medial sub-sartorial approach was initially used to identify and protect the femoral vessels, followed by identification of the sciatic nerve and its branches. Three patients required only the medial approach, while five required an additional lateral incision to safely protect the common peroneal nerve and achieve en-bloc resection. No intra-operative amputations were performed.

Conclusions: Dual incision, dual surgeon approach for soft tissue sarcoma resection in the distal femur allows for effective limb salvage, reduced operative time, and improved intra-operative decision-making. This technique minimizes radiation exposure and ensures adequate exposure of distorted regional anatomy, facilitating safer tumour resection.

Keywords: Distal femur; dual incision; limb salvage; neurovascular protection; soft tissue sarcoma