Early Vascular Consultation in the Setting of Oncologic Resections: Benefit for Patients and a Continuing Source of Open Vascular Surgical Training

Mogannam, Abid; Paz, Carlos Chavez de; Sheng, Neha; Patel, Sheela T.; Bianchi, Christian; Chiriano, Jason; Teruya, Theodore H.; Abou-Zamzam, Ahmed M.

doi:10.1016/j.avsg.2014.11.022

Cited by 18 publications

(19 citation statements)

References 22 publications

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“…It is clear that the proper management of major vessels is part of the routine work of an orthopedic oncology surgeon, but this poses challenges to patient safety with a need for change in the way we approach patient care in surgery. A surgical team in which orthopedic and vascular surgeons cooperate has been associated with decreased morbidity and complications, and improved outcomes for the patients [ 5 , 6 , 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

The Orthopedic-Vascular Multidisciplinary Approach Improves Patient Safety in Surgery for Musculoskeletal Tumors: A Large-Volume Center Experience

Angelini

Piazza

Pagliarini

et al. 2021

JPM

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Objective: Wide-margin resection is mandatory for malignant bone and soft tissue tumors. However, this increases the complexity of resections, especially when vessels are involved. Patients in this high-risk clinical setting could be surgically treated using the multidisciplinary orthopedic-vascular approach. This study was carried out in this healthcare organization to evaluate patient safety in term of oncologic outcomes and reduction of the complication rate. Materials and Methods: We retrospectively reviewed 74 patients (37 males, 37 females; mean age 46 years, range 9–88) who underwent surgical excision for bone/soft tissue malignant tumors closely attached to vascular structures from October 2015 to February 2019. Vascular surgery consisted of isolation of at least one vessel (64 patients), bypass reconstruction (9 patients), and end-to-end anastomosis (1 patient). Mean follow-up was 27 months. Patients’ demographics, tumor characteristics, adjuvant treatments, type of orthopedic and vascular procedures, and oncologic and functional outcomes and complications were recorded. Results: Overall survival was 85% at 3 years follow-up. In total, 22 patients experienced at least one major complication requiring further surgery and 13 patients experienced at least one minor complication, whereas 17 reported deviations from the normal postoperative course without the need for pharmacological or interventional treatment. Major complications were higher in pelvic resections compared to limb-salvage procedures (p = 0.0564) and when surgical time was more than 4 h (p = 0.0364 at univariate analysis, whereas the most important multivariate independent predictors for major complications were pelvic resection (p = 0.0196) and preoperative radiotherapy (p = 0.0426). Conclusions: A multidisciplinary ortho-vascular approach for resection of malignant bone and soft tissue tumors tightly attached to important vascular structures should be considered a good clinical practice for patient safety.

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Section: Introductionmentioning

confidence: 99%

The Orthopedic-Vascular Multidisciplinary Approach Improves Patient Safety in Surgery for Musculoskeletal Tumors: A Large-Volume Center Experience

Angelini

Piazza

Pagliarini

et al. 2021

JPM

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“…2,3 The current literature has shown the utility of intraoperative vascular surgery assistance for vascular access and reconstruction by nonvascular surgeons and the additional benefit of these cases for the development and training of vascular surgery trainees. [4][5][6] With this in mind, the purpose of this study was to evaluate the case load of the vascular division in oncologic resections of sarcomas at our institution and to identify risk factors associated with increased mortality among this cohort.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Sarcoma Resections Requiring Vascular Surgical Assistance: A Single-Center Experience

Nooromid

Thomas

Yoon

et al. 2020

Vasc Endovascular Surg

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Objective: To describe the types of intervention and determine patency and survival after arterial and venous reconstruction after surgical excision of sarcomas. Methods: Between November 2001 and July 2015, 42 patients with sarcomas and vascular involvement underwent surgical oncologic resection followed by arterial or venous reconstruction or preservation of the native vascular bundle. Univariate, multivariate, and Kaplan-Meier survival analyses were performed on abstracted data, which included demographics, risk factors, oncologic and vascular treatment modalities, postoperative complications, graft patency, and survival outcomes. Results: A total of 42 sarcomas required vascular assistance for oncologic removal. The majority of sarcomas were malignant fibrous histiocytoma (23.8%), and the most common anatomic location was the retroperitoneum (48%). A total of 12 revascularizations procedures were performed, including 5 arterial, 3 venous, and 2 concomitant arterial and venous. In 32 cases, a vascular surgeon was needed for vessel ligation, repair, or mobilization. The overall 2- and 5-year survival was 77.7% and 26.2%, respectively, with no significant survival difference between patients who underwent revascularization compared to those without revascularization. There was a 100% patency rate in all cases at last follow-up, regardless of the type of vascular reconstruction (median 18 months, range 1-29 months). On multivariate analysis, chronic obstructive pulmonary disease (COPD; P = .002) and positive surgical margins ( P = .003) were associated with decreased survival. Most cases were performed in the last 5 years of the study (n = 27, 64.3%). Conclusions: Vascular reconstruction is feasible after surgical oncologic resection of sarcomas with good mid-term patency and limb preservation. Factors independently associated with mortality included COPD and positive surgical margins.

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“…However, literature suggests experienced surgeons can perform these complex IVC resections and reconstructions safely 26. Due to increased complication risks, previous reports have recommended the utilization of intraoperative vascular consultation in cases requiring major vascular resection, reporting fewer vascular injuries and a trend toward lower blood loss and improved survival 38. While direct comparison of complications was beyond the scope of this study, 16% of patients with en-bloc IVC resection in our series had a severe postoperative complication as deemed by a Clavien-Dindo score of >IIIa 23.…”

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confidence: 99%

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

Blair

Reames

Singh

et al. 2018

Journal of Surgical Oncology

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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.

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Early Vascular Consultation in the Setting of Oncologic Resections: Benefit for Patients and a Continuing Source of Open Vascular Surgical Training

Cited by 18 publications

References 22 publications

The Orthopedic-Vascular Multidisciplinary Approach Improves Patient Safety in Surgery for Musculoskeletal Tumors: A Large-Volume Center Experience

The Orthopedic-Vascular Multidisciplinary Approach Improves Patient Safety in Surgery for Musculoskeletal Tumors: A Large-Volume Center Experience

Outcomes of Sarcoma Resections Requiring Vascular Surgical Assistance: A Single-Center Experience

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

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