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

Abstract

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.

Surgical and oncologic outcomes following arterial resection and reconstruction for advanced solid tumors

“…Overall, our experience with long‐term vascular graft patency (80%) is in line with previous reports of arterial patency following oncologic resection which have ranged from 58% to 100% 10 . Our series further supports the feasibility and safety of cryopreserved homografts in the setting of multivisceral resection, including kidney and segmental bowel resection, for which data in the literature are currently limited.…”

“…Previous studies in the literature have reported 2‐year survival rates ranging from 50.2% to 77.7% for patients undergoing sarcoma resections with vascular resection and reconstruction 10 . By contrast, the 2‐year survival rate for sarcoma patients in our series was 100%, although our results are limited by our small sample size.…”

“…31 Overall, our experience with long-term vascular graft patency (80%) is in line with previous reports of arterial patency following oncologic resection which have ranged from 58% to 100%. 10 Our series further supports the feasibility and safety of cryopreserved homografts in the setting of multivisceral resection, including kidney and segmental bowel resection, for which data in the literature are currently limited. Among five of our patients (56%) who had kidney and/or bowel resection as part of their tumor excision surgery and underwent arterial reconstruction with cryopreserved homografts, four patients (80%) have uninterrupted patency and one patient developed asymptomatic graft stenosis under ongoing surveillance only.…”

“…Recent studies have demonstrated favorable oncologic outcomes utilizing vascular resection and reconstruction in the setting of locally advanced soft tissue sarcomas (STS) 4–7 and gynecologic malignancies 8 . However, limited data exist describing perioperative and oncologic/vascular outcomes in cases requiring multivisceral resection, as concomitant resection of the kidney and/or the small or large intestine may impact morbidity and outcomes of vascular reconstruction, including choice of vascular conduit 9,10 . Additionally, it remains unclear whether long‐term oncologic outcomes justify the invasive and morbid nature of such operations, particularly in the treatment of recurrent disease where previous surgical and/or oncologic therapy—especially a remote history of radiotherapy (RT)—are known to impact surgical outcomes 11,12 …”

“…8 However, limited data exist describing perioperative and oncologic/ vascular outcomes in cases requiring multivisceral resection, as concomitant resection of the kidney and/or the small or large intestine may impact morbidity and outcomes of vascular reconstruction, including choice of vascular conduit. 9,10 Additionally, it remains unclear whether long-term oncologic outcomes justify the invasive and morbid nature of such operations, particularly in the treatment of recurrent disease where previous surgical and/or oncologic therapy-especially a remote history of radiotherapy (RT)-are known to impact surgical outcomes. 11,12 Given the relatively limited data describing the various outcomes of tumor resection with vascular reconstruction and the lack of consensus regarding the indications and contraindications for such procedures for both STS and other malignancies, [13][14][15] we sought to evaluate our institutional outcomes for arterial resection and reconstruction in a contemporary cohort of patients (including those with complex/protracted oncologic history) where complex surgical resection of locally and regionally advanced solid tumors involving major arteries was performed.…”