Carpenter Susanne G, Stone William M, Bower Thomas C, Fowl Richard J, Money Samuel R
Mayo Clinic Arizona, Phoenix, AZ 85054, USA.
Ann Vasc Surg. 2011 Nov;25(8):1026-35. doi: 10.1016/j.avsg.2011.05.005. Epub 2011 Jul 20.
This study investigates surgical management of tumors arising from or involving the aorta and major arterial structures.
A retrospective single institutional review was conducted of patients undergoing arterial resection for tumors involving the aorta or major arterial structures between January 1992 and May 2009 at a tertiary care center. Patients with tumors abutting arteries without necessitating resection and those involving only venous structures were excluded. Patients were analyzed in groups by vessel involvement: aorta, carotid, external/common iliac, internal iliac, superficial femoral, and miscellaneous.
Sixty patients were identified and included for review. The iliac arteries were most often resected, and sarcomatous pathology was most common (37 patients, 62%). Twelve patients underwent aortic resection, with eight (67%) of these undergoing graft reconstruction, one (8%) graft patch, and two (17%) primary repair. None of the 17 patients undergoing internal iliac resection underwent reconstruction, whereas the majority of patients in all other groups underwent reconstruction. Thirty-day mortality (TDM) was 0% in all groups, except the aortic (2/12, 17% TDM), and internal iliac arteries (1/17, 6% TDM). Estimated blood loss varied widely and was not significantly different between vessel groups (p = 0.280). Overall, 44 of 60 (73%) patients had negative margins. Fourteen patients (23%) returned to the operating room, most for wound infection or dehiscence. Mean follow-up was 20.25 months (range: 0.5-122.0 months, SD: 23 months). Forty patients were followed up for more than 1 year. Thus, with an overall median follow-up of 12.25 months, overall survival was 60% with disease-free survival of 40%.
Resection of tumors involving the aorta and major arterial structures provides a reasonable option for treatment, but with significant perioperative morbidity. In selected patients, this aggressive intervention should be considered.
本研究调查源于主动脉及主要动脉结构或累及这些部位的肿瘤的手术治疗方法。
对1992年1月至2009年5月在一家三级医疗中心因累及主动脉或主要动脉结构的肿瘤而接受动脉切除术的患者进行回顾性单机构研究。毗邻动脉但无需切除的肿瘤患者以及仅累及静脉结构的患者被排除。根据血管受累情况将患者分为以下几组：主动脉、颈动脉、髂外/总动脉、髂内动脉、股浅动脉和其他。
共确定60例患者并纳入研究。髂动脉最常被切除，肉瘤病理类型最为常见（37例，62%）。12例患者接受了主动脉切除术，其中8例（67%）进行了移植物重建，1例（8%）进行了移植物补片修补，2例（17%）进行了一期修复。17例接受髂内动脉切除术的患者均未进行重建，而其他所有组的大多数患者都进行了重建。除主动脉组（2/12，17%的30天死亡率）和髂内动脉组（1/17，6%的30天死亡率）外，所有组的30天死亡率均为0%。估计失血量差异很大，各血管组之间无显著差异（p = 0.280）。总体而言，60例患者中有44例（73%）切缘阴性。14例患者（23%）返回手术室，多数是因为伤口感染或裂开。平均随访时间为20.25个月（范围：0.5 - 122.0个月，标准差：23个月）。40例患者随访时间超过1年。因此，总体中位随访时间为12.25个月，总生存率为60%，无病生存率为40%。
切除累及主动脉和主要动脉结构的肿瘤为治疗提供了一种合理的选择，但围手术期发病率较高。对于特定患者，应考虑这种积极的干预措施。
