Optimizing isolated limb perfusion in malignant melanoma and sarcoma

Isolated hyperthermic limb perfusion (ILP) is a limb-salvage technique used in the treatment of malignant melanoma and soft tissue sarcomas with in-transit or locally advanced disease. ILP allows regional administration of high-dose chemotherapy with minimal systemic toxicity. This study aims to evaluate postoperative complications and identify predictive factors influencing outcomes in patients undergoing ILP. We retrospectively analyzed 49 patients with malignant melanoma or extremity soft tissue sarcoma who underwent ILP at a single tertiary center between 2014 and 2024. Complications were classified using the Clavien-Dindo system; toxicity was graded via the Wieberdink scale. Logistic regression and univariate analyses were used to evaluate clinical, surgical, and laboratory parameters predictive of severe complications, toxicity, and mortality. Of the patients, 32 (65.3%) experienced complications, primarily within the first 3 postoperative days. Severe complications (Clavien-Dindo grade ≥ 3) occurred in 11 patients (22.4%). Severe regional toxicity (Wieberdink grade ≥ 4) was observed in 6.1%. Early mortality occurred in 3 cases. Preoperative and postoperative albumin levels, along with C-reactive protein levels on postoperative days 3 and 5, were significantly associated with severe complications. No significant relationship was found between modified Systemic Inflammation Scores and postoperative outcomes. ILP remains a valuable regional treatment option for carefully selected patients with advanced melanoma and extremity soft tissue sarcoma. Preoperative nutritional status and early postoperative inflammatory markers, particularly albumin and C-reactive protein, may serve as valuable predictors for adverse outcomes. Optimization of these parameters could improve postoperative recovery and treatment planning.