Stefano Radaelli1, Marco Fiore2, Chiara Colombo3, Samuel Ford4, Elena Palassini5, Roberta Sanfilippo6, Silvia Stacchiotti7, Claudia Sangalli8, Carlo Morosi9, Paolo G Casali10, Alessandro Gronchi11. 1. Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: stefano.radaelli@istitutotumori.mi.it. 2. Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: marco.fiore@istitutotumori.mi.it. 3. Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: chiara.colombo@istitutotumori.mi.it. 4. Department of Surgery, University Hospital, Birmingham, United Kingdom. Electronic address: samuel.ford@uhb.nhs.uk. 5. Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: elena.palassini@istitutotumori.mi.it. 6. Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: roberta.sanfilippo@istitutotumori.mi.it. 7. Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: silvia.stacchiotti@istitutotumori.mi.it. 8. Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: claudia.sangalli@istitutotumori.mi.it. 9. Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: carlo.morosi@istitutotumori.mi.it. 10. Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: paolo.casali@istitutotumori.mi.it. 11. Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: alessandro.gronchi@istitutotumori.mi.it.
Abstract
BACKGROUND: To analyze the outcome of a series of patients who underwent vascular resection as part of an excision of a soft tissue sarcoma (STS). STUDY DESIGN: All consecutive patients affected by localized STS of an extremity or retroperitoneum treated between January 2000 and December 2013 with surgery including vascular resection were considered. Overall survival (OS), crude cumulative incidence (CCI) of local recurrence (LR) and distant metastases (DM) were estimated by Kaplan-Meier. Long-term vascular graft patency rate was assessed. RESULTS: 2692 patients received an operation for localized disease with 105 (3.9%) cases undergoing vascular resection. Median FU was 32 months. 5-year OS, CCI of LR and DM were 62%, 12% and 58% respectively. Vascular reconstructions consisted of 52 arterial and 16 venous grafts in extremities; 12 arterial and 33 venous grafts in the retroperitoneum. Graft thrombosis occurred in 16 patients (7/64 arterial and 9/49 venous reconstructions). Arterial occlusions occurred at a median of 36 months after surgery and were treated by prosthesis replacement (3), Fogarty catheter embolectomy (2), percutaneous angioplasty (1) and observation (1). One patient eventually required amputation. Venous occlusions occurred at a median of 4 months post surgery and were all treated conservatively. Overall arterial and venous reconstruction patency rates were 89% and 82% respectively. CONCLUSIONS: Vascular resection to facilitate resection of STS has an acceptable long term patency rate. However it was associated to a high risk of distant spread. Although the encasement of the vascular bundle does not represent a contraindication to surgery there is an association with a high metastatic risk by virtue of the locally advanced nature of the disease and this should be considered when planning treatment.
BACKGROUND: To analyze the outcome of a series of patients who underwent vascular resection as part of an excision of a soft tissue sarcoma (STS). STUDY DESIGN: All consecutive patients affected by localized STS of an extremity or retroperitoneum treated between January 2000 and December 2013 with surgery including vascular resection were considered. Overall survival (OS), crude cumulative incidence (CCI) of local recurrence (LR) and distant metastases (DM) were estimated by Kaplan-Meier. Long-term vascular graft patency rate was assessed. RESULTS: 2692 patients received an operation for localized disease with 105 (3.9%) cases undergoing vascular resection. Median FU was 32 months. 5-year OS, CCI of LR and DM were 62%, 12% and 58% respectively. Vascular reconstructions consisted of 52 arterial and 16 venous grafts in extremities; 12 arterial and 33 venous grafts in the retroperitoneum. Graft thrombosis occurred in 16 patients (7/64 arterial and 9/49 venous reconstructions). Arterial occlusions occurred at a median of 36 months after surgery and were treated by prosthesis replacement (3), Fogarty catheter embolectomy (2), percutaneous angioplasty (1) and observation (1). One patient eventually required amputation. Venous occlusions occurred at a median of 4 months post surgery and were all treated conservatively. Overall arterial and venous reconstruction patency rates were 89% and 82% respectively. CONCLUSIONS: Vascular resection to facilitate resection of STS has an acceptable long term patency rate. However it was associated to a high risk of distant spread. Although the encasement of the vascular bundle does not represent a contraindication to surgery there is an association with a high metastatic risk by virtue of the locally advanced nature of the disease and this should be considered when planning treatment.
Authors: Alex B Blair; Bradley N Reames; Jasvinder Singh; Faiz Gani; Heidi N Overton; Robert J Beaulieu; Ying W Lum; James H Black; Fabian M Johnston; Nita Ahuja Journal: J Surg Oncol Date: 2018-06-07 Impact factor: 3.454
Authors: Maria Anna Smolle; Dimosthenis Andreou; Per-Ulf Tunn; Joanna Szkandera; Bernadette Liegl-Atzwanger; Andreas Leithner Journal: EFORT Open Rev Date: 2017-10-17