Oncovascular Surgery: Essential Roles of Vascular Surgeons in Cancer Surgery

Abstract

For the modern practice of cancer surgery, the concept of oncovascular surgery (OVS), defined as cancer resection with concurrent ligation or reconstruction of a major vascular structure, can be very important. OVS for advanced cancers requires specialized procedures performed by a specialized multidisciplinary team. Roles of oncovascular surgeons are summarized as: a primary surgeon in vesselorigin tumors, a rescue surgeon treating complications during cancer surgery, and a consultant surgeon as a multidisciplinary team for cancer surgery. Vascular surgeons must show leadership in cancer surgery in cases of complex advanced diseases, such as angiosarcoma, leiomyosarcoma, intravenous leiomyomatosis, retroperitoneal soft tissue sarcoma, iatrogenic injury of the major vessels during cancer surgery, pancreatic cancer with vascular invasion, extremity soft tissue sarcoma, melanoma and others.

Keywords: Cancer; Oncovascular procedures; Soft tissue sarcoma; Vascular surgery.

Fig. 1

(A) Initial outside computed tomography revealed a 19×18 mm saccular outpouching lesion of the aorta immediately above the aortic bifurcation (arrow). (B) The lesion increased up to 21×36 mm in 50 days (arrow). (C, D) Positron emission tomography revealed hypermetabolic lesions in the aorta (arrows), bilateral common iliac, and right inguinal area, suggestive of an infected aneurysm and reactive inflammation.

Fig. 2

Retroperitoneal leiomyosarcoma arise in the infrarenal inferior vena cava extending up to the right atrium.

Fig. 3

Computed tomography images of intravenous leiomyomatosis. (A) Tumor is located inside the inferior vena cava, arising from the pelvis and growing proximally with the blood flow. (B) The proximal end of the tumor is located inside the right atrium.

Fig. 4

Resected specimen of the tumor shows the intracardiac portion on the left and fragmented tumor from the pelvis on the right. The tumor is firm with a glistening surface that is unlikely to cause an embolism.

Fig. 5

Preoperative computed tomography suggests the tumor abutting on the portal vein and vena cava. Pathology resulted in a follicular dendritic cell sarcoma without invasion.

Fig. 6

Various reconstruction of the portomesenteric vein after en bloc resection of pancreatic cancer. (A) Primary end-to-end anastomosis of the portal vein (PV), (B) primary repair with a bovine patch, (C) interposition graft with a short tubular graft made of a bovine patch, and (D) an interposition graft with a spiral graft made of saphenous vein. GSV, great saphenous vein; SMV, superior mesenteric vein.