Aggressive surgical approach with vascular resection and reconstruction for retroperitoneal sarcomas: a systematic review

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.

Surgical outcomes of major vascular resection for retroperitoneal liposarcoma from a high‑volume sarcoma center: a propensity score matching analysis

“…Our study showed similar 5-year LRFS and OS rates between patients with and without the vascular resection in the matched cohort (LRFS: P = 0.74, OS: p = 0.12, respectively). This finding was comparable to those reported by Hu et al (Hu et al 2023 ) and Blair et al (Blair et al 2018 ). Vascular resection was also not an independent predictor influencing LRFS and OS in patients with RLPS.…”

Unresectable leiomyosarcoma of the inferior vena cava with right atrium tumor thrombus: when to deem this tumor inoperable? A case report and literature review

“…The meta-analysis showed that vascular resection did not improve RFS or OS compared with tumor resection alone. Vascular resection was also associated with a higher rate of major complications in one study, but no deaths were reported in two studies (19). When managing an intracardiac tumor thrombus, resection is preferred and intraoperative CPB should be considered to facilitate resection and maintain perfusion (20)(21)(22).…”