Fueglistaler Philipp, Gurke Lorenz, Stierli Peter, Obeid Tamim, Koella Christoph, Oertli Daniel, Kettelhack Christoph
University Centre for Vascular Surgery, Aarau/Basel, and Department of General Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
World J Surg. 2006 Jul;30(7):1344-9. doi: 10.1007/s00268-005-0555-2.
Involvement of major vascular structures has been considered a limiting factor for resecting advanced tumors. The objective of this study was to evaluate the outcome after concomitant retroperitoneal tumor and vascular resection with prosthetic replacement of the aorta/vena cava.
The authors reviewed a 5-year series of eight patients with a median age of 50 years (range 11-68 years) who had undergone resection of a retroperitoneal tumor and concomitant resection and replacement of the abdominal aorta, inferior vena cava, or both. The histologic diagnoses were sarcoma (five patients), teratoma (one), transitional cell carcinoma (one), and ganglioneuroma (one). The main outcome measures were early (<30 days) and late (>or=30 days) surgical morbidity and mortality. Secondary endpoints were vascular graft patency and tumor-free survival. Two patients underwent combined graft replacement of the aorta and vena cava. Single aortic and vena cava graft replacement were each done in three patients.
Two patients showed early surgical morbidity necessitating reoperation for a thrombotic graft occlusion. No patient died during the early course of the follow-up. During a median follow-up of 14 months (range 1-56 months), two patients had late surgical morbidity. The median tumor-free survival for patients with malignancy was 14 months (range 1-54 months). One patient developed locoregional tumor recurrence, and two developed distant metastases. The median survival for patients with malignancy was 14 months (range 1-60 months).
An aggressive surgical approach for otherwise unresectable retroperitoneal tumors with vascular resection and prosthetic vascular replacement is justified in selected cases and has acceptable morbidity and mortality.
主要血管结构受累一直被视为切除晚期肿瘤的限制因素。本研究的目的是评估同时进行腹膜后肿瘤切除及人工血管置换主动脉/腔静脉后的结果。
作者回顾了一个为期5年的系列研究，纳入8例患者，中位年龄50岁（范围11 - 68岁），这些患者均接受了腹膜后肿瘤切除，同时进行了腹主动脉、下腔静脉或两者的切除及置换。组织学诊断为肉瘤（5例）、畸胎瘤（1例）、移行细胞癌（1例）和神经节瘤（1例）。主要观察指标为早期（<30天）和晚期（≥30天）手术并发症及死亡率。次要终点为血管移植物通畅率和无瘤生存率。2例患者接受了主动脉和腔静脉联合移植置换。3例患者分别进行了单一主动脉和腔静脉移植置换。
2例患者出现早期手术并发症，因血栓形成导致移植物闭塞而需再次手术。随访早期无患者死亡。中位随访14个月（范围1 - 56个月）期间，2例患者出现晚期手术并发症。恶性肿瘤患者的中位无瘤生存期为14个月（范围1 - 54个月）。1例患者发生局部肿瘤复发，2例发生远处转移。恶性肿瘤患者的中位生存期为14个月（范围1 - 60个月）。
对于其他无法切除的腹膜后肿瘤，采用积极的手术方法进行血管切除及人工血管置换在某些病例中是合理的，且具有可接受的发病率和死亡率。
