Resection of retroperitoneal sarcoma en‐bloc with inferior vena cava: 20 year outcomes of a single institution

Abstract

Background: Margin negative resection offers the best chance of long-term survival in retroperitoneal sarcoma (RPS). En-bloc resection of adjacent structures, including the inferior vena cava (IVC), is often required to achieve negative margins. We review our 20-year experience of en-bloc IVC and RPS resection. Methods: Retrospective review of patients with RPS resection involving the IVC were matched 1:3 by age and histology to RPS without IVC resection. Prognostic factors for overall survival (OS) and disease free survival (DFS) were assessed. Results: Thirty-two patients underwent RPS resection en-bloc with IVC. They were matched with 96 cases of RPS without IV Cresection. Median OS of 59 months and DFS 18 months in IVC resection group was comparable to RPS resection without vascular involvement: median OS 65 months, DFS 18 months (P = 0.519, P = 0.604). On multivariate analyses, R2 margin (OS: HR = 6.52 [95%CI: 1.18–36.09], P = 0.032) was associated with inferior OS. R2 margin and increased number of organs resected (DFS: HR = 5.07, [1.15–22.27], P = 0.031, HR = 1.28 [1.01–1.62], P = 0.014) were associated with inferior DFS. Reconstructions included graft (n = 19, 59%), patch (n = 4, 13%), primary repair (n = 6, 19%), and ligation (n = 4, 13%). Conclusions: RPS resection en-bloc with IVC can achieve equivalent rates of DFS and OS to patients without vascular involvement.

Feasibility of Retrohepatic Inferior Vena Cava Resection Without Reconstruction for Hepatic Alveolar Echinococcosis

“…In recent years, there have been many reports on IVC resection and reconstruction, 24,25 and there are still few reports of IVC resection without reconstruction. 26 Alex et al proposed that resection without reconstruction can be performed after the establishment of collateral circulation for low-grade retroperitoneal sarcoma. In their report, 3 cases (9%) accepted IVC resection without reconstruction, and all these patients recovered well.…”

“…In their report, 3 cases (9%) accepted IVC resection without reconstruction, and all these patients recovered well. 26 In addition, Hardwigse et al also reported IVC resection without reconstruction for 6 patients with hepatic carcinoma. 23 From our point of view, the reason that IVC resection without reconstruction was not widely accepted in patients of retroperitoneal tumors may be as follows: (a) retroperitoneal tumors grow rapidly and rarely form sufficient collateral circulation when invading IVC; (b) even if adequate collateral circulation has been established for some low-grade retroperitoneal tumors, it still needs wide retroperitoneal resection, which could destroy the established collateral reflux and cause serious postoperative complications.…”

Vascular Involvement in Primary Retroperitoneal Tumors

“…By matching 1:3 retroperitoneal sarcomas resection involving the IVC by age and histology to retroperitoneal masses without IVC resection, they have concluded that en-bloc resection including the IVC can be performed safely, with disease-free and overall survival rates similar to those encountered in patients without IVC involvement [46,47]. A strong collaboration with a specialised vascular surgeon is needed [48]. Grotemeyer et al concluded that after the resection of the IVC, a PTFE graft should be interposed in combination with an AV fistula, due to the fact that, in their study, the only patients that developed graft thrombosis were those without an AV fistula [49].…”

A vena cava inferiort infiltráló májtumorok kapcsán végzett reszekciókról

“…Az ilyen kiterjesztett műtétek indikációi között hepatocellularis carcinoma, intrahepaticus cholangiocarcinoma és metasztázis egyaránt szerepelt, de leírtak vena cava inferior reszekciót retroperitonealis tumor [9] műtétjénél és a vena cava primer leiomyosarcomája miatt is [10].…”