Results of venous resections and reconstructions in retroperitoneal tumors

Abstract

Background. Retroperitoneal tumors are rare, heterogeneous malignant neoplasms. Due to the low sensitivity of tumor to chemoradiation, surgical resection is the only curative treatment method for retroperitoneal sarcomas. Performance of radical surgery improves the outcome for these patients. There are little data about the results of the treatment of the patients who underwent en bloc resection of the retroperitoneal tumors combined with the resection of large vessel.Aim. To analyze surgical and oncological outcomes of treatment retroperitoneal neoplasms with vascular involvement. Materials and methods. From 2019 to 2022, 27 patients with retroperitoneal sarcomas underwent surgical treatment with the resection of large vessels during the period.Results. The average diameter of the tumors was 17 (11–39) cm. The most common histological type was moderately differentiated liposarcoma (33.4 %), followed by pleomorphic liposarcoma (22.2 %), highly differentiated (18.5 %), undifferentiated sarcoma (18.5 %), leiomyosarcoma (7.4 %). Resection of the suprarenal segment of the inferior vena cava (IVC) with prosthetics was performed in 4 cases, resection of the renal segment with renal vein reimplantation – in 1 case, resection of the infrarenal segment of the IVC with prosthetics – in 8 cases. A synthetic prosthesis was used as a conduit in all cases. Tangential resection of the suprarenal IVC portion was performed in 1 patient, infrarenal portion – in 5 patients. A resection of the infrarenal IVC portion was performed without reconstruction in 1 case. Resection of the iliac vein was required in 6 patients; in one case the resection of the arterial iliac segment and prosthetics was added. Complete resection (R0–R1) was achieved in 85.2 % of the cases. The incidence of postoperative complications went as far as 25.9 % with no postoperative mortality. Despite ongoing anticoagulant therapy, the frequency of thrombosis in venous reconstruction zone in the early postoperative period (1 month) was 7.4 %. The median relapse-free survival was 16 months, and the median of overall survival was not achieved.Conclusion. Combined operations with the excision of retroperitoneal malignancies and angioplasty have explicitly acceptable level of postoperative complications and mortality. Eradication of retroperitoneal tumor with large vessels invasion allows to enlarge the life expectancy of patients often considered to be inoperable.