Oncovascular compartmental resection for retroperitoneal soft tissue sarcoma with vascular involvement

Bertrand, Martin; Carrère, Sébastien; Delmond, Laure; Mehta, Sanket; Rouanet, Philippe; Canaud, Ludovic; Alric, Pierre; Quénet, François

doi:10.1016/j.jvs.2016.04.006

Cited by 38 publications

(32 citation statements)

References 28 publications

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“…Similarly, an R2 resection was independently associated with inferior OS with a trend toward R1 resection and an increase in number of organs resected and inferior OS (Table ). A complete resection with negative margins has repeatedly been shown to be essential to maximize the chance for long term survival in RPS . As seen in our study, prior reports have also associated multivisceral resection with inferior survival for RPS .…”

Section: Discussionsupporting

confidence: 77%

“…[11][12][13][14] Similar findings have been reported in multiple small case series of multivisceral RPS resections performed at high volume institutions. [15][16][17][18][19][20][21] However, due to the rarity of this disease, present existing series are often small in size, include extremity sarcomas in analyses, or investigate primary leiomyosarcoma of the IVC only.…”

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confidence: 99%

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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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Section: Discussionsupporting

confidence: 77%

mentioning

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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“…Tumor size, histologic subtype, malignancy grade, and multifocality were significant tumor‐related predictors of the outcome with patterns of recurrence depending on the histologic subtype . In another series of patients who received oncovascular surgery, microscopically confirmed vascular invasion did not increase the local recurrence, which is probably because of the margin enhancement obtained by the vessel resection …”

Section: Prognosismentioning

confidence: 90%

“…However, the odds ratios (ORs) of the comparison of the presence and absence of morbidity between absence and presence of vascular resection were well above 1, even after performing an adjustment for the number of organs resected . In another retrospective study of 126 patients who received oncovascular surgery, which included 31 patients with RPS, the reintervention rate was 16%, and an early thrombosis of the inferior vena cava prosthesis developed in one patient. However, there were no post‐operative deaths in this study.…”

Section: Morbiditymentioning

confidence: 98%

Major vascular resections in retroperitoneal sarcoma

Tzanis

Bouhadiba

Gaignard

et al. 2017

Journal of Surgical Oncology

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Retroperitoneal sarcomas (RPS) frequently involve major vessels, which either originate from them or secondarily encase or invade them. In this field, major vascular resections result in increased morbidity. However, survival does not seem to be affected by the need for vascular resection or by this higher morbidity. This paper aims to provide descriptions of the surgical strategy and outcomes for retroperitoneal sarcomas involving major vessels.

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“…Tumor infiltration is a rare cause of aortic rupture. Besides the germ cell testicular cancer [ 16 ], abdominal aortic invasion has also been reported in other types of malignancies as soft tissue sarcomas [ 17 – 20 ], paragangliomas [ 21 ], lymphomas [ 22 ] and gynecological tumors [ 23 ]. Most authors consent that endovascular aortic intervention is an effective and safe method which should be encouraged to provide a definite therapeutic impact in a subset of patients who would otherwise not be candidates for curative surgery.…”

Section: Discussionmentioning

confidence: 99%

Successful emergency endovascular aortic repair for intratumoral hemorrhage in extensive retroperitoneal mass of testicular origin

Huľová

Aziri

Vulev³

et al. 2020

BMC Surg

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Background Metastatic germ cell cancer of the testis is characterized by favorable prognosis since effective treatment methods are available even in cases of extensive disease. Retroperitoneal masses frequently encroach major blood vessels requiring a vascular intervention usually performed in association with the post-chemotherapy retroperitoneal lymph node dissection (RPLND). Reported clinical case describes a successful pre-treatment endovascular surgery for abdominal aortic rupture allowing for full-dose systemic chemotherapy administration, and subsequent radical surgical intervention at primary tumor site as well as metastatic retroperitoneal lymph node dissection including the reconstruction of inferior caval vein. Case presentation Patient presented with left-sided testicular tumor and voluminous retroperitoneal mass with vascular involvement. Soon after the patient had been admitted for the first cycle of cisplatin-based chemotherapy, computed tomographic angiography (CTA) revealed a dorsal aortic wall rupture with active extravasation and irregular pseudoaneurysmatic dilatation of the aorta below the leak area. Retroperitoneal intratumoral hemorrhage associated with the bilateral iliac venous thrombosis required an endovascular repair procedure of infrarenal abdominal aorta. Conclusions Following the successful endovascular aortic repair 3 cycles of BEP (bleomycin, etoposide, cisplatin) regimen were administered with subsequent delayed left radical orchiectomy and RPLND associated with vena cava inferior (VCI) resection. Reconstruction of VCI was originally not deemed necessary as collateral blood flow appeared sufficient, however, intraoperative complications resulted in the need for unilateral VCI reconstruction, using the interposed bypass between right common iliac vein and infrarenal segment of VCI. Histopathologic examination of the attained specimen detected no vital cancer structures. The patient remains disease-free 18 months after the RPLND.

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Oncovascular compartmental resection for retroperitoneal soft tissue sarcoma with vascular involvement

Cited by 38 publications

References 28 publications

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

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

Major vascular resections in retroperitoneal sarcoma

Successful emergency endovascular aortic repair for intratumoral hemorrhage in extensive retroperitoneal mass of testicular origin

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