Purpose: Vascular involvement is a major limitation in attaining limb salvage with negative margins for managing soft tissue sarcomas (STS). The study evaluated surgical and oncological outcomes of vascular resection and reconstruction during the management of extremities STS. Methods: The study involved 60 patients with STS treated with limb-sparing surgery divided into two groups; the reconstruction Group (n=30) needed vascular reconstruction (Vr) due to vascular involvement, and the

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... truction Group (n=30) did not require vascular resection. All patients were followed up for at least one year to compare surgical and oncological outcomes. Results: Vascular reconstruction involved a major artery and vein (n=16), a major artery alone (n=13), or a major vein alone (n=1). Most patients (n = 22) had Vr with a saphenous vein graft. An artificial Gore-Tex graft was used in the other cases. A primary vascular repair was possible for the femoral artery in 3 more patients. Major wound complications, DVT, and persistent severe edema were more frequent in the reconstruction Group (p = 0.004 0.015, and 0.001, respectively). Amputation was eventually required in 17% of the reconstruction group and a single patient in the non-reconstruction group. The overall survival (OS) at 18 months was apparently higher in the reconstruction group (85.9%) than the non-reconstruction group (64.7%, p = 0.063). On multivariate analysis, age at diagnosis and surgical margin were the independent factors affecting OS. The functional outcome of both groups was similar (p= 0.676). Conclusion: En-bloc resection of major vascular structures with the tumor and reconstruction has proven to be a feasible option in limb-salvage surgery. Vascular resection en bloc with limb sarcoma in locally advanced disease increases the safety of the surgical margins and gives comparable life expectancy and rFS to limb sarcoma patients with early disease who were treated with resection without vascular involvement. However, it keeps the advantage of having preserved functioning limb.