Bertrand Martin Marie, Carrère Sébastien, Delmond Laure, Mehta Sanket, Rouanet Philippe, Canaud Ludovic, Alric Pierre, Quénet François
Surgical Oncology Department, Institut régional du Cancer de Montpellier (ICM), Montpellier, France.
Surgical Oncology Department, Saifee Hospital, Mumbai, Maharashtra, India.
J Vasc Surg. 2016 Oct;64(4):1033-41. doi: 10.1016/j.jvs.2016.04.006. Epub 2016 Jun 30.
This study analyzed the outcomes of a series of consecutive patients diagnosed with a retroperitoneal soft tissue sarcoma (RSTS) with vascular involvement and who underwent a multidisciplinary operation.
Between 2000 and 2013, 126 patients were referred for oncovascular surgery in our institution. Among these, 31 consecutive patients underwent operations for RSTS with vascular involvement. A vascular/oncologic team determined the surgical strategy preoperatively.
Median follow-up was 34.4 months (interquartile range, 48.1 months). Twenty patients (65%) were referred for primary RSTS and 11 (35%) for local recurrence. The most common histologic diagnosis was liposarcoma (54.8%), mainly high-grade and intermediate-grade RSTS. Prosthetic grafts were usually used for vascular reconstruction. Median hospital stay was 17 days (interquartile range, 14.5; range, 7-190 days). The grade 3 and 4 morbidity rate was 19.3%. Each resection was macroscopically complete (R0-R1). Median progression-free survival was 10 months, and median overall survival was not reached. Overall survival rates were 77.4% at 1 year and 61.3% at 3 years.
Vascular resection and reconstruction are safe and feasible in case of RSTS. The morbidity rate was acceptable, and there were no perioperative deaths. Despite recurrence rates that remain high, oncovascular resection enhances resection margins and allows encouraging survival results for patients often considered as nonresectable.
本研究分析了一系列连续诊断为伴有血管受累的腹膜后软组织肉瘤（RSTS）且接受多学科手术的患者的治疗结果。
2000年至2013年期间，126例患者被转诊至我院接受血管肿瘤手术。其中，31例连续患者接受了伴有血管受累的RSTS手术。血管/肿瘤团队在术前确定手术策略。
中位随访时间为34.4个月（四分位间距为48.1个月）。20例患者（65%）因原发性RSTS转诊，11例（35%）因局部复发转诊。最常见的组织学诊断为脂肪肉瘤（54.8%），主要为高级别和中级别RSTS。人工血管移植物通常用于血管重建。中位住院时间为17天（四分位间距为14.5天；范围为7 - 190天）。3级和4级并发症发生率为19.3%。每次切除在宏观上均为完整切除（R0 - R1）。中位无进展生存期为10个月，中位总生存期未达到。1年总生存率为77.4%，3年总生存率为61.3%。
对于RSTS患者，血管切除和重建是安全可行的。并发症发生率可接受，且无围手术期死亡。尽管复发率仍然很高，但血管肿瘤切除可提高切除切缘，并为通常被认为不可切除的患者带来令人鼓舞的生存结果。
