Outcome of iliocaval resection and reconstruction for retroperitoneal sarcoma

Abstract

Objective: The aim of this study was to investigate the oncologic and surgical outcomes of patients treated with inferior vena cava (IVC) or iliac vein (IV) resection for retroperitoneal sarcoma (RPS). Surgery is the only curative option for patients with primary RPS. The IVC or IV can be directly invaded by RPS or can be the organ of origin of retroperitoneal leiomyosarcoma. In both cases, resection of the IVC or IV is required to achieve a complete resection.

Methods: Patients who underwent IVC or IV resection for primary or recurrent RPS between 2000 and 2016 at a single referral institution were included in this retrospective study. The oncologic outcome was explored in terms of overall survival and crude cumulative incidence (CCI) of local recurrence and distant metastasis. Surgical outcomes were explored in terms of complications, renal function, lower limb edema, and vascular graft patency.

Results: Sixty-seven patients were included: 24 IV resections (IV group), 39 IVC resections, and 4 IVC and IV resections (IVC group). The most frequent histologic types were leiomyosarcoma (63%) and liposarcoma (27%). Five-year overall survival, CCI of local recurrence, and CCI of distant metastasis (95% confidence interval) were 56.2% (43.6-72.4), 12.4% (5.2-29.5), and 51.5% (39.3-67.5). IVC was circumferentially resected in 38 of 43 patients; 32 were treated with graft reconstruction (22 with interposition of banked venous homograft [BVH] and 10 with polytetrafluoroethylene [PTFE] graft) and 6 with ligation only, mostly dependent on the presence of an adequate collateral vessel network. Patients with preoperative IVC obstruction treated with ligation only (n = 6) did not develop severe postoperative lower limb edema. IVC graft primary patency at 5 years was 100% in IVC PTFE grafts and 76.7% in IVC BVHs. Fifteen patients (22.4%) suffered a Clavien-Dindo grade ≥3 complication within 60 days of surgery.

Conclusions: IVC or IV resection in the context of RPS surgery is of value in achieving long-term survival. A policy of vascular grafting in case of circumferential resection of a patent IVC or IV is rewarding. For IVC reconstruction, both BVHs and PTFE grafts offer good results in terms of high patency rate and low risk of infection.

Keywords: Banked venous homograft; Inferior vena cava; Leiomyosarcoma; Retroperitoneal sarcoma; Surgical resection; Vascular reconstruction.