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Delcarro A, Coubeau L. Inferior vena cava reconstruction with non-fascial autologous peritoneum: Retrospective study and literature review. World J Surg 2024; 48:978-988. [PMID: 38502051 DOI: 10.1002/wjs.12127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/25/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Inferior vena cava (IVC) resection is essential for complete (R0) excision of some malignancies. However, the optimal material for IVC reconstruction remains unclear. Our objective is to demonstrate the efficacy, safety, and advantages of using Non-Fascial Autologous Peritoneum (NFAP) for IVC reconstruction. To conduct a literature review of surgical strategies for tumors involving the IVC. METHODS We reviewed all IVC reconstructions performed at our institution between 2015 and 2023. Preoperative, operative, postoperative, and follow-up data were collected and analyzed. RESULTS A total of 33 consecutive IVC reconstructions were identified: seven direct sutures, eight venous homografts (VH), and 18 NFAP. With regard to NFAP, eight tubular (mean length, 12.5 cm) and 10 patch (mean length, 7.9 cm) IVC reconstructions were performed. Resection was R0 in 89% of the cases. Two patients had Clavien-Dindo grade I complications, 2 grade II, 2 grade III and 2 grade V complications. The only graft-related complication was a case of early partial thrombosis, which was conservatively treated. At a mean follow-up of 25.9 months, graft patency was 100%. There were seven recurrences and six deaths. Mean overall survival (OS) was 23.4 months and mean disease-free survival (DFS) was 14.4 months. According to our results, no statistically significant differences were found between NFAP and VH. CONCLUSIONS NFAP is a safe and effective alternative for partial or complete IVC reconstruction and has many advantages over other techniques, including its lack of cost, wide and ready availability, extreme handiness, and versatility. Further comparative studies are required to determine the optimal technique for IVC reconstruction.
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Affiliation(s)
| | - Laurent Coubeau
- Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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Maclean E, Delriviere L, Johansson M, Hodder R. Resection of previously inoperable retroperitoneal liposarcoma. BMJ Case Rep 2023; 16:e256479. [PMID: 37945281 PMCID: PMC10649782 DOI: 10.1136/bcr-2023-256479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
We present a case of successful resection of a large right upper quadrant retroperitoneal dedifferentiated liposarcoma involving multiple adjacent organs, initially considered inoperable in a patient in his 40s. This case highlights the importance of extensive preoperative planning and a multidisciplinary approach in achieving a greater chance of curative resection. Preoperative optimisation included neoadjuvant chemotherapy, concurrent portal vein embolisation and hepatic vein embolisation. The patient then underwent en-bloc resection, including total pancreatectomy, hemihepatectomy and vena caval resection in conjunction with extracorporeal membrane oxygenation and percutaneous venovenous bypass.
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Affiliation(s)
- Ellen Maclean
- Department of General Surgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Luc Delriviere
- Department of Surgical Transplant, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Mikael Johansson
- Department of General Surgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Rupert Hodder
- Department of General Surgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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Hu H, Guo Q, Zhao J, Huang B, Du X. Aggressive surgical approach with vascular resection and reconstruction for retroperitoneal sarcomas: a systematic review. BMC Surg 2023; 23:275. [PMID: 37700246 PMCID: PMC10498574 DOI: 10.1186/s12893-023-02178-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND AND AIM Surgery is the mainstay of treatment and completeness of surgical resection is critical to achieve local control for retroperitoneal sarcoma (RPS). En-bloc resection of adjacent organs, including major abdominal vessels, is often required to achieve negative margins. The aim of this review was to summarise the available evidence to assess the relative benefits and disadvantages of an aggressive surgical approach with vascular resection in patients with retroperitoneal sarcoma (RPS). METHODS We searched PubMed, the Cochrane Library, and EMBASE for relevant studies published from inception up to August 1, 2022. We performed a systematic review of the available studies to assess the safety and long-term survival results of vascular resection for RPS. RESULTS We identified a total of 23 studies for our review. Overall postoperative in-hospital or 30-day mortality rate of patients with primary iliocaval leiomyosarcoma was 3% (11/359), and the major complication rate was 13%. The recurrence-free survival (RFS) rates after the follow-up period varied between 15% and 52%, and the 5-year overall survival (OS) rates ranged from 25 to 78%. Overall postoperative in-hospital or 30-day mortality rate of patients with RPSs receiving vascular resection was 3%, and the major complication rate was 27%. The RFS rates after the follow-up period were 18-86%, and the 5-year OS rates varied between 50% and 73%. There were no significant differences in the rates of RFS (HR: 0.97; 95% CI: 0.74-1.19; p = 0.945) and OS (HR: 1.01; 95% CI: 0.66-1.36; p = 0.774) between the extended resection group and tumour resection alone group. CONCLUSIONS With adequate preparation and proper management, for patients with RPSs involving major vessels, aggressive surgical approach with vascular resection can achieve R0/R1 resection and improve survival.
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Affiliation(s)
- Hankui Hu
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Qiang Guo
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
| | - Jichun Zhao
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Bin Huang
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Xiaojiong Du
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
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Guo Q, Zhao J, Du X, Hu H, Huang B. Incidence, risk factors, and outcomes of venous thromboembolism in patients undergoing surgery for retroperitoneal tumors: a propensity-matched retrospective cohort study. Int J Surg 2023; 109:2689-2695. [PMID: 37578462 PMCID: PMC10498861 DOI: 10.1097/js9.0000000000000429] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/21/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a common postoperative complication; however, the incidence and risk stratification of postoperative VTE in patients with retroperitoneal tumor remains unclear. The authors aim to quantify the incidence, identify risk factors, and determine the outcomes of VTE in patients undergoing retroperitoneal tumor surgery. METHODS The authors retrospectively reviewed the characteristics, perioperative outcomes, and overall survival (OS) of patients (VTE and non-VTE) who underwent retroperitoneal tumor surgery between 2015 and 2020. Perioperative and oncologic outcomes were compared using propensity-matching and Cox analyses. RESULTS Of 1223 patients with retroperitoneal tumor surgery, 2.1% had VTE. Age [odds ratio (OR) 1.140, 95% CI: 1.053-1.239, P =0.004], recurrence (OR 1.851, 95% CI: 1.241-2.761, P =0.003), and vascular resection (OR 2.036, 95% CI: 1.054-3.934, P =0.034) were independent risk factors, with significant between-group differences regarding age, recurrence, sarcoma, organ resection, vascular resection, and operation time. No between-group differences in 30-day all-cause mortality (8 vs. 4%, OR 0.657, 95% CI: 0.375-1.151, P =0.427) and major complications (12 vs. 8%, OR 0.775, 95% CI: 0.483-1.244, P =0.572) were observed. Mean hospitalization duration (20.1 vs. 22.9 days, OR 1.153, 95% CI: 1.022-1.386, P =0.033) and ICU stay (3.2 vs. 5.5 days, OR 1.193, 95% CI: 1.034-1.347, P =0.012) were shorter in non-VTE versus VTE, respectively, with inferior OS (hazard ratio 2.090, 95% CI: 1.014-4.308, P =0.046) in VTE. CONCLUSIONS Age, recurrence, and vascular resection are positively associated with VTE, which is associated with inferior OS.
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Affiliation(s)
| | | | | | | | - Bin Huang
- Department of General Surgery, Division of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
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Rebelo A, Bayram O, Grilli M, Ukkat J, Kleeff J, Ronellenfitsch U. A Systematic Review and Meta-Analysis of Surgery for Retroperitoneal Sarcoma With Vascular Resection. Cureus 2023; 15:e43544. [PMID: 37719606 PMCID: PMC10502323 DOI: 10.7759/cureus.43544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/19/2023] Open
Abstract
This meta-analysis examines the outcomes of patients undergoing surgery with vascular resection for retroperitoneal sarcoma. A systematic literature search based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted, identifying five comparative retrospective cohort studies published from 2015 to 2021, with a total of 1,417 patients (180 in the vascular resection (VR) group and 1,237 in the control (no VR) group). The meta-analysis found that 30-day morbidity rates, as classified by Clavien-Dindo classification > 3, were higher in the VR group compared to the no VR group (46% versus 25%, odds ratio (OR): 1.84, 95% confidence interval (CI): 0.39-8.69, p=0.44). Local recurrence rates during the follow-up period were similar between the two groups (30% versus 30%, OR: 1.46, 95% CI: 0.50-4.25, p=0.49). However, distant recurrence was more frequent in the VR group (32% versus 8.5%, OR: 2.54, 95% CI: 1.05-6.13, p=0.04). In conclusion, although oncovascular procedures are feasible for patients with retroperitoneal sarcomas, the long-term outcomes appear to be worse when compared to procedures that do not involve vessel resections.
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Affiliation(s)
- Artur Rebelo
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle, DEU
| | - Onur Bayram
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle, DEU
| | - Maurizio Grilli
- Library of the Medical Faculty Mannheim, Heidelberg University, Mannheim, DEU
| | - Jörg Ukkat
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle, DEU
| | - Joerg Kleeff
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle, DEU
| | - Ulrich Ronellenfitsch
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle, DEU
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BAIA M, NAUMANN DN, WONG CS, MAHMOOD F, PARENTE A, BISSACCO D, ALMOND M, FORD SJ, TIROTTA F, DESAI A. Dealing with malignancy involving the inferior vena cava in the 21st century. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:664-673. [DOI: 10.23736/s0021-9509.22.12408-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Wong D, Hockley J, Parys S, Hodder R, Jansen S, Newman M. Current Technology Venous-Venous Bypass Improves the Safety of Resection of Sarcoma and Benign Retroperitoneal Tumours Involving the Inferior Vena Cava. Eur J Vasc Endovasc Surg 2022; 64:575-576. [PMID: 35964890 DOI: 10.1016/j.ejvs.2022.07.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 06/19/2022] [Accepted: 07/22/2022] [Indexed: 01/12/2023]
Affiliation(s)
- Damian Wong
- Sir Charles Gairdner Hospital, Perth, Western Australia; Royal Perth Hospital, Perth, Western Australia.
| | - Joe Hockley
- Sir Charles Gairdner Hospital, Perth, Western Australia; School of Medicine, Curtin University, Perth, Western Australia; Heart and Vascular Research Institute, Harry Perkins Institute for Medical Research, Perth, Western Australia
| | - Simon Parys
- Sir Charles Gairdner Hospital, Perth, Western Australia
| | - Rupert Hodder
- Sir Charles Gairdner Hospital, Perth, Western Australia; School of Medicine, Curtin University, Perth, Western Australia
| | - Shirley Jansen
- Sir Charles Gairdner Hospital, Perth, Western Australia; School of Medicine, Curtin University, Perth, Western Australia; Heart and Vascular Research Institute, Harry Perkins Institute for Medical Research, Perth, Western Australia; School of Biomedical Sciences, University of Western Australia, Perth, Western Australia
| | - Mark Newman
- Sir Charles Gairdner Hospital, Perth, Western Australia; School of Biomedical Sciences, University of Western Australia, Perth, Western Australia
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Maimaitinijiati Y, AJi T, Jiang TM, Ran B, Shao YM, Zhang RQ, Guo Q, Wang ML, Wen H. Approaches to reconstruction of inferior vena cava by ex vivo liver resection and autotransplantation in 114 patients with hepatic alveolar echinococcosis. World J Gastroenterol 2022; 28:4351-4362. [PMID: 36159005 PMCID: PMC9453774 DOI: 10.3748/wjg.v28.i31.4351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/10/2022] [Accepted: 07/25/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatic alveolar echinococcosis (AE) is most commonly found in retrohepatic inferior vena cava (RHIVC). Ex vivo liver resection and autotransplantation (ELRA) can better realize the radical resection of end-stage hepatic AE with severely compromised hepatocaval confluences, and reconstruction of the affected vessels. Currently, there is a scarcity of information regarding RHIVC reconstruction in ELRA.
AIM To propose reasonable RHICV reconstruction strategies for ex vivo liver resection and autotransplantation.
METHODS We retrospectively summarized the clinical data of 114 patients diagnosed with hepatic AE who treated by ELRA in our department. A total of 114 patients were divided into three groups according to the different reconstruction methods of RHIVC: Group A with original RHIVC being repaired and reconstructed (n = 64), group B with RHIVC being replaced (n = 43), and group C with RHIVC being resected without reconstruction (n = 7). The clinical data of patients, including the operation time, anhepatic phase, intraoperative blood loss, complications and postoperative hospital stay, were analyzed and the patients were routinely followed up. The normally distributed continuous variables were expressed as means ± SD, whereas the abnormally distributed ones were expressed as median and analyzed by analysis of variance. Survival curve was plotted by the Kaplan-Meier method.
RESULTS All patients were routinely followed up for a median duration of 52 (range, 12-125) mo. The 30 d mortality rate was 7.0% (8/114) and 7 patients died within 90 d. Among all subjects, the inferior vena cava (IVC)-related complication rates were 17.5% (11/63) in group A and 16.3% (7/43) in group B. IVC stenosis was found in 12 patients (10.5%), whereas thrombus was formed in 6 patients (5.3%). Twenty-two patients had grade III or higher complications, with the complication rates being 17.2%, 16.3%, and 57.1% in the three groups. The average postoperative hospital stay in the three groups was 32.3 ± 19.8, 26.7 ± 18.2, and 51.3 ± 29.4 d (P = 0.03), respectively.
CONCLUSION ELRA can be considered a safe and feasible option for end-stage hepatic AE patients with RHIVC infiltration. The RHIVC reconstruction methods should be selected appropriately depending on the defect degree of AE lesions in IVC lumen. The RHIVC resection without any reconstruction method should be considered with caution.
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Affiliation(s)
- Yusufukadier Maimaitinijiati
- State Key Laboratory on Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, The First Clinical College, Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Tuerganaili AJi
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Tie-Min Jiang
- State Key Laboratory on Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, The First Clinical College, Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Bo Ran
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Ying-Mei Shao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
- Xinjiang Organ Transplant Institution, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Rui-Qing Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Qiang Guo
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Mao-Lin Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
| | - Hao Wen
- State Key Laboratory on Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, The First Clinical College, Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
- Xinjiang Organ Transplant Institution, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China
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Palacios AR, Schmeusser BN, Midenberg E, Patil D, Xie L, Nabavizadeh R, Ogan K, Cardona K, Maithel SK, Master VA. Resection of retroperitoneal tumors with inferior vena cava involvement without caval reconstruction. J Surg Oncol 2022; 126:1306-1315. [PMID: 35943295 DOI: 10.1002/jso.27052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 07/24/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Retroperitoneal tumors with involvement of the inferior vena cava (IVC) often require resection of the IVC to achieve complete tumor removal. This study evaluates the safety and efficacy of IVC ligation without caval reconstruction. METHODS A retrospective chart review of patients who underwent IVC ligation (IVC-Ligation) and IVC resection with reconstruction (IVC-Reconstruction) at our institution between May 2004 and April 2021 was performed. Outcomes from the two surgical techniques were compared via univariate analysis using the Kruskal-Wallis test for continuous variables and Fisher's exact test for categorical variables. RESULTS Forty-nine IVC-Ligation and six IVC-Reconstruction surgeries were identified. There were no differences in baseline demographics, tumor characteristics, complication rates, postoperative morbidity, or overall 5-year survival between groups. IVC-Reconstruction patients were more likely to require intensive care unit admission (83% vs. 33%; p = 0.0257) and the IVC-Ligation cohort had a tendency to present with nondebilitating postoperative lymphedema (35% vs. 0%; p = 0.1615), which resolved for most patients. CONCLUSIONS IVC-Ligation is a viable surgical option for select patients presenting with retroperitoneal tumors with IVC involvement and provides acceptable short- and medium-term outcomes.
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Affiliation(s)
- Arnold R Palacios
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Eric Midenberg
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dattatraya Patil
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lillian Xie
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Reza Nabavizadeh
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kenneth Ogan
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kenneth Cardona
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Shishir K Maithel
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
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Intravascular Ultrasound for the Evaluation and Management of Retroperitoneal, Genitourinary Malignancies. Curr Urol Rep 2022; 23:67-73. [PMID: 35286591 DOI: 10.1007/s11934-022-01092-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Herein we provide a review of intravascular ultrasound (IVUS) and its ability to assist in the evaluation and surgical management of advanced retroperitoneal, genitourinary tumors. RECENT FINDINGS Advanced retroperitoneal tumors such as advanced renal cell carcinoma, bulky retroperitoneal lymphadenopathy associated with advanced testicular carcinoma, large adrenal tumors, and retroperitoneal sarcomas can invade, compress, or distort vascular anatomy making surgical resection challenging and high risk. Intravascular ultrasonography is commonly used by vascular and cardiothoracic surgery to provide a real time assessment of vascular invasion, compression, and aberrant anatomy to assist with pre-operative and/or intraoperative decision-making. However, the application of this technology to assist with cancer surgery has been limited. The use of intravascular ultrasound prior to radical, extirpative, retroperitoneal surgery involving large vessels can aid in the planning and execution of such challenging operations.
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11
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Saikia J, Rastogi S, Barwad A, Dhamija E, Pandey R, Bhoriwal S, Deo S, Kumar S. A systematic review of the current management approaches in leiomyosarcoma of inferior vena cava-Results from analysis of 118 cases. Asian Cardiovasc Thorac Ann 2021; 30:349-363. [PMID: 34672808 DOI: 10.1177/02184923211049911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Primary intravenous leiomyosarcomas are rare vascular tumors with aggressive disease biology. The diagnosis and management have been challenging as little data exist from large databases. METHODS A literature search was done to identify all cases of primary leiomyosarcomas in the last five years. Clinicopathological features and management strategies were evaluated. RESULTS The median age was 53 years, predominantly females (2.5:1), presenting as metastases in up to 12.1% cases. Most tumors were locally advanced with a median size of 10cm. Inferior vena cava involvement from renal veins to infrahepatic veins remains the most frequent site (57.1%cases) while nearly half (52.8%) proceeded for surgery without histological proof. Most patients could undergo upfront resection (88.0%) with few patients receiving neoadjuvant chemotherapy (4.3%) or neoadjuvant radiotherapy (2.2%). Significant multivisceral resections included right nephrectomy (41.3%), liver resection (25.7%) and left nephrectomy (2.2%). Most patients (91.8%) needed an inferior vena cava graft placement with remarkable microscopically negative margins (85.5% cases). Doxorubicin and ifosfamide were the most frequently used combination chemotherapy regimens in both pre and postoperative settings with partial responses. The median overall and disease free survival among operated patients was 60 months and 28 months respectively. In multivariate analysis large tumor, extensive inferior vena cava involvement, and need for adjuvant chemotherapy appeared significant predictors for overall survival. CONCLUSIONS Aggressive upfront surgical resection with clear margin remains the key for long-term survival. Doxorubicin-based regimens were preferred as neoadjuvant chemotherapy while adjuvant treatment with chemotherapy, radiotherapy, or both may be considered in high-risk patients.
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Affiliation(s)
- Jyoutishman Saikia
- Department of Surgical Oncology, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Rastogi
- Department of Medical Oncology, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Adarsh Barwad
- Department of Pathology, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Ekta Dhamija
- Department of Radiodiagnosis, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Rambha Pandey
- Department of Radiotherapy, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Bhoriwal
- Department of Surgical Oncology, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Suryanarayana Deo
- Department of Surgical Oncology, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Sunil Kumar
- Department of Surgical Oncology, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
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12
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Noël JP, Tang SYW, Muhammad NAL, Nicol D, Kockelbergh RC. A cut above? Inferior vena cava resection without reconstruction: a dual-centre experience. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/2051415820947638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To evaluate outcomes in our patients undergoing inferior vena cava (IVC) resection without reconstruction, as part of an adrenal/renal cell cancer (RCC) operation. Methods: British Association of Urological Surgeons (BAUS) Data and Audit System records were obtained for two operating surgeons, each at geographically separate urological cancer centres. Retrospectively reviewed case notes of patients who had undergone IVC resection without reconstruction as part of an adrenal/RCC operation, assessing operative parameters, length of stay, complications and follow-up status. Results: A total of Twenty-eight patients (20 right-sided tumours, 8 left sided) underwent IVC resection without reconstruction in May 2013–February 2017. No perioperative or early deaths occurred. Fourteen patients (50%) had complications: sepsis; pneumonia; congestive cardiac failure; acute kidney injury; symptomatic peripheral deep venous thrombosis; splenectomy; and significant chyle leak. At a median follow-up of 21 months (range 1–55 months) six patients (21.4%) have died and two patients (7.1%) progressed to metastatic disease, giving a 71.4% progression-free survival in this series. Conclusions: This case series illustrates our experience of IVC resection without reconstruction as an acceptably safe procedure. This should be considered as an alternative to graft reconstruction, particularly as minimal invasive approaches are being adopted. Level of Evidence: 3
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Affiliation(s)
- Jonathan P Noël
- Department of Urology, Royal Marsden NHS Foundation Trust, UK
| | | | | | - David Nicol
- Department of Urology, Royal Marsden NHS Foundation Trust, UK
| | - Roger C Kockelbergh
- Department of Urology, University Hospitals of Leicester NHS Trust, UK
- University Hospitals of Leicester NHS Trust, UK
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13
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Balzan SMP, Gava VG, Magalhaes MA, Rieger A, Roman LI, Dos Santos C, Marins MP, Rabaioli B, Raupp IT, Kunzler VB. Complete and partial replacement of the inferior vena cava with autologous peritoneum in cancer surgery. J Surg Oncol 2021; 124:665-668. [PMID: 34159613 DOI: 10.1002/jso.26558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 11/07/2022]
Abstract
Resection of the inferior vena cava may be required in the courses of oncological surgeries for the tumors originating from or invading it. Management of the remaining defect depends on the extension of the resection. Partial or complete replacement of the inferior vena cava, with a patch or interposition graft, may be required. Standard techniques for the reconstruction with a prosthetic material or the autologous veins can be associated with the prosthetic graft infection, high cost, long-standing anticoagulation, technical difficulties, and/or need for extra incisions. The use of the autologous peritoneum represents an easy and inexpensive alternative for the partial and complete inferior vena cava reconstructions.
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Affiliation(s)
- Silvio M P Balzan
- Postgraduate Program in Health Promotion (PPGPS) and Life Sciences Department, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil.,Oncological Center Lydia Wong Ling, Hospital Moinhos de Vento, Porto Alegre, Brazil.,Saint Gallen Ações e Terapias em Saúde, Santa Cruz do Sul, Brazil.,Cancer League, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
| | - Vinicius G Gava
- Oncological Center Lydia Wong Ling, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | - Alexandre Rieger
- Postgraduate Program in Health Promotion (PPGPS) and Life Sciences Department, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil.,Biotechnology and Genetics Laboratory, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
| | - Luiz I Roman
- Cancer League, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
| | - Caroline Dos Santos
- Cancer League, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
| | - Morgana P Marins
- Cancer League, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
| | - Bruna Rabaioli
- Cancer League, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
| | - Isabela T Raupp
- Cancer League, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
| | - Vanessa B Kunzler
- Cancer League, University of Santa Cruz do Sul (UNISC), Santa Cruz do Sul, Brazil
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Kung JW, Chong CC, Lee KF, Wong J, Lai PB, Ng KK. Novel use of the falciform ligament for reconstruction of the inferior vena cava and its tributary. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:425-428. [PMID: 34278076 PMCID: PMC8263530 DOI: 10.1016/j.jvscit.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 05/02/2021] [Indexed: 11/25/2022]
Abstract
Tumor invasion into the inferior vena cava (IVC) and hepatic vein (HV) is challenging in cancer surgery with curative intent. Appropriate techniques for venous reconstruction are essential. We have described in detail a novel technique of fashioning an interposition tube graft using the falciform ligament to reconstruct the IVC and HV. The falciform ligament maintains all the benefits of an autologous tissue graft, with the added advantage of its flexibility in customizing graft dimensions. Its use in IVC and HV reconstruction has rarely been reported. The short-term outcomes with this tube graft are promising.
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Affiliation(s)
- Janet W.C. Kung
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong Special Administrative Region, People's Republic of China
| | - Charing C.N. Chong
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong Special Administrative Region, People's Republic of China
- Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, People's Republic of China
| | - Kit-Fai Lee
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong Special Administrative Region, People's Republic of China
| | - John Wong
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong Special Administrative Region, People's Republic of China
| | - Paul B.S. Lai
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong Special Administrative Region, People's Republic of China
- Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, People's Republic of China
| | - Kelvin K.C. Ng
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong Special Administrative Region, People's Republic of China
- Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, People's Republic of China
- Correspondence: Kelvin K. C. Ng, MBBS, MS, PhD, FRCSEd (Gen), Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing St, New Territories, Hong Kong Special Administrative Region, People's Republic of China
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15
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Squires MH, Politano S, Pollock RE, Chen JL, Grignol V. Modern multimodality management of patients with caval leiomyosarcoma: New treatment paradigms and potential molecular insights. J Surg Oncol 2021; 123:1618-1623. [PMID: 33650695 DOI: 10.1002/jso.26442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Caval leiomyosarcomas (cLMS) are rare soft tissue sarcomas historically associated with high recurrence rates and poor prognosis. While radical resection remains the mainstay of therapy for cLMS, new systemic therapies have presented opportunities for multimodality treatment. We examined the clinical outcomes of patients with cLMS treated with modern, multimodality approaches, and compared their outcomes to those of patients with noncaval retroperitoneal LMS (ncLMS). METHODS A retrospective, single-institution review identified all patients diagnosed with primary retroperitoneal LMS from 2012 to 2018. Radiographic and pathologic review distinguished patients with cLMS and ncLMS. Standard clinicopathologic variables and response to chemotherapy (when applicable) were analyzed. Primary endpoints were overall (OS) and progression-free survival (PFS). RESULTS Eleven patients with cLMS were identified. Median tumor size was 7.5 cm (IQR, 5.0-14.3 cm); all patients had Stage II/III disease. Seven patients received neoadjuvant chemotherapy. Nine cLMS patients underwent R0/R1 resection; two did not complete resection. Six patients received adjuvant systemic therapy. Twenty patients with ncLMS were treated during the same period. No statistical intergroup differences were noted in tumor size, pathologic grade, stage, or resection margin status. Patients with ncLMS were less likely to receive neoadjuvant (10% vs. 64%) and adjuvant chemotherapy (30% vs. 55%). Two-year OS (81% vs. 78%; p = NS) and PFS (55% vs. 46%; p = NS) were comparable between cLMS and ncLMS patients. CONCLUSIONS Multimodality treatment with systemic therapy and aggressive surgical resection may achieve equivalent survival outcomes for patients with cLMS versus similar ncLMS. We recommend that all patients with cLMS be evaluated for multidisciplinary treatment. Genomic and proteomic expression profiling may identify novel or targetable mutations.
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Affiliation(s)
- Malcolm H Squires
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Stephen Politano
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Raphael E Pollock
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - James L Chen
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA.,Division of Bioinformatics, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
| | - Valerie Grignol
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
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Homsy P, Blomqvist C, Heiskanen I, Vikatmaa L, Tukiainen E, Numminen K, Sampo M, Leppäniemi A, Albäck A, Kantonen I, Vikatmaa P. Multidisciplinary Oncovascular Surgery is Safe and Effective in the Treatment of Intra-abdominal and Retroperitoneal Sarcomas: A Retrospective Single Centre Cohort Study and a Comprehensive Literature Review. Eur J Vasc Endovasc Surg 2020; 60:752-763. [DOI: 10.1016/j.ejvs.2020.05.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/23/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022]
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Ran B, Maimaitinijiati Y, Yasen A, Jiang T, Zhang R, Guo Q, Shao Y, Wen H, Aji T. Feasibility of Retrohepatic Inferior Vena Cava Resection Without Reconstruction for Hepatic Alveolar Echinococcosis. Am Surg 2020; 87:443-449. [PMID: 33026233 DOI: 10.1177/0003134820951457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This study evaluates the feasibility of retrohepatic inferior vena cava (RHIVC) resection without reconstruction in patients with end-stage hepatic alveolar echinococcosis (AE). Four hundred and fifty-seven patients diagnosed with hepatic AE and who underwent surgical resections between January 2010 and October 2018 were retrospectively analyzed. Nine patients receiving RHIVC resection without reconstruction were included in this study. Among the patients, 5 were male and 4 female. Mean follow-up time was 64.4 months (18-95). In this series, adequate collateral circulation was formed before operation in all patients, and 7 cases underwent ex vivo liver resection and autotransplantation (ELRA) and 2 cases underwent extended right hemi-hepatectomy. Average standard liver volume, graft volume, surgical time, and anhepatic phase in ELRA group patients was 1144 ± 127 cm3, 740 ± 235 cm3, 16.8 ± 4.1 hours, and 337.4 ± 108.65 minutes respectively. Average hospital stay time for all patients was 45 ± 36.4 days. There were no intraoperative deaths. The 30-day mortality rate was 11.1%, and total mortality rate was 22.2%. Postoperative complications occurred in 4 patients. During follow-up, no relapsed AE lesions were found. RHIVC resection without reconstruction is a feasible way for hepatic AE patients with adequate collateral circulation. Careful protection of collateral venous is the key factor for successful operation.
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Affiliation(s)
- Bo Ran
- 159427 State Key Laboratory on Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, Xinjiang, China.,Department of Liver Hydatid Disease, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.,74790 Xinjiang Key Laboratory of Echinococcosis, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yusufukadier Maimaitinijiati
- 159427 State Key Laboratory on Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, Xinjiang, China.,Department of Liver Hydatid Disease, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.,74790 Xinjiang Key Laboratory of Echinococcosis, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Aimaiti Yasen
- 159427 State Key Laboratory on Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, Xinjiang, China.,Department of Liver Hydatid Disease, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.,74790 Xinjiang Key Laboratory of Echinococcosis, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Tieming Jiang
- Department of Liver Hydatid Disease, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Ruiqing Zhang
- Department of Liver Hydatid Disease, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Qiang Guo
- Department of Liver Hydatid Disease, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yingmei Shao
- 159427 State Key Laboratory on Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, Xinjiang, China.,Department of Liver Hydatid Disease, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.,74790 Xinjiang Key Laboratory of Echinococcosis, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Hao Wen
- 159427 State Key Laboratory on Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, Xinjiang, China.,Department of Liver Hydatid Disease, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.,74790 Xinjiang Key Laboratory of Echinococcosis, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Tuerganaili Aji
- 159427 State Key Laboratory on Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Xinjiang Medical University, Urumqi, Xinjiang, China.,Department of Liver Hydatid Disease, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.,74790 Xinjiang Key Laboratory of Echinococcosis, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
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Contralateral internal iliac artery transposition for retroperitoneal sarcoma involving common iliac artery. Updates Surg 2020; 74:1157-1163. [PMID: 32602011 DOI: 10.1007/s13304-020-00843-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/25/2020] [Indexed: 01/20/2023]
Abstract
Complete resection for retroperitoneal sarcoma (RPS) involving major vessels frequently requires vascular resection and reconstruction. The use of artificial grafts often leads to postoperative vascular graft infection (VGI), which usually requires reoperation and sometimes leads to death. In the present study, the data of RPS patients who underwent contralateral iliac artery (IIA) transposition for reconstruction of the common iliac artery (CIA) after RPS resection from 2015-2019 were retrospectively analyzed. Clinical, intraoperative, and postoperative outcomes were described. Contralateral IIA transposition was performed to reconstruct the CIA after segmental resection in three patients. All patients underwent concomitant organ resection. Colon resection was performed for all patients, nephrectomy was performed for two patients, and segmental resection of the left ureter with transurethral ureterostomy was performed for one patient. Complete resection was achieved in all patients, and microscopic tumor infiltration to the CIA was observed in all patients (tunica adventitia: 2, tunica media: 1). No major complications occurred during the hospital stay. During the follow-up period (6.0-29.1 months), one patient died from tumor recurrence, and the other two patients did not have any evidence of recurrence or metastatic disease at the latest follow-up. The level of lower limb function was favorable (MSTS93 scores: 28-30). The pelvic organ functions, including bowel, bladder, and sexual functions, were not impaired in any of the patients. This novel technique in which contralateral IIA transposition is performed to reconstruct the CIA after RPS resection is simple and reliable and may be a good alternative to artificial grafts.
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Outcome of iliocaval resection and reconstruction for retroperitoneal sarcoma. J Vasc Surg Venous Lymphat Disord 2019; 7:547-556. [DOI: 10.1016/j.jvsv.2018.10.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/26/2018] [Indexed: 11/23/2022]
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