Department of Cardiovascular Surgery, ASST Ovest Milanese, A.O. Ospedale Civile di Legnano, Legnano, Italy.
Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
J Vasc Surg Venous Lymphat Disord. 2019 Jul;7(4):547-556. doi: 10.1016/j.jvsv.2018.10.023. Epub 2019 Feb 18.
The aim of this study was to investigate the oncologic and surgical outcomes of patients treated with inferior vena cava (IVC) or iliac vein (IV) resection for retroperitoneal sarcoma (RPS). Surgery is the only curative option for patients with primary RPS. The IVC or IV can be directly invaded by RPS or can be the organ of origin of retroperitoneal leiomyosarcoma. In both cases, resection of the IVC or IV is required to achieve a complete resection.
Patients who underwent IVC or IV resection for primary or recurrent RPS between 2000 and 2016 at a single referral institution were included in this retrospective study. The oncologic outcome was explored in terms of overall survival and crude cumulative incidence (CCI) of local recurrence and distant metastasis. Surgical outcomes were explored in terms of complications, renal function, lower limb edema, and vascular graft patency.
Sixty-seven patients were included: 24 IV resections (IV group), 39 IVC resections, and 4 IVC and IV resections (IVC group). The most frequent histologic types were leiomyosarcoma (63%) and liposarcoma (27%). Five-year overall survival, CCI of local recurrence, and CCI of distant metastasis (95% confidence interval) were 56.2% (43.6-72.4), 12.4% (5.2-29.5), and 51.5% (39.3-67.5). IVC was circumferentially resected in 38 of 43 patients; 32 were treated with graft reconstruction (22 with interposition of banked venous homograft [BVH] and 10 with polytetrafluoroethylene [PTFE] graft) and 6 with ligation only, mostly dependent on the presence of an adequate collateral vessel network. Patients with preoperative IVC obstruction treated with ligation only (n = 6) did not develop severe postoperative lower limb edema. IVC graft primary patency at 5 years was 100% in IVC PTFE grafts and 76.7% in IVC BVHs. Fifteen patients (22.4%) suffered a Clavien-Dindo grade ≥3 complication within 60 days of surgery.
IVC or IV resection in the context of RPS surgery is of value in achieving long-term survival. A policy of vascular grafting in case of circumferential resection of a patent IVC or IV is rewarding. For IVC reconstruction, both BVHs and PTFE grafts offer good results in terms of high patency rate and low risk of infection.
本研究旨在探讨因腹膜后肉瘤（RPS）而接受下腔静脉（IVC）或髂静脉（IV）切除术患者的肿瘤学和手术结果。手术是原发性 RPS 患者的唯一治愈方法。IVC 或 IV 可直接被 RPS 侵犯，也可成为腹膜后平滑肌肉瘤的起源器官。在这两种情况下，都需要切除 IVC 或 IV 以实现完全切除。
本回顾性研究纳入了 2000 年至 2016 年间在一家转诊机构接受原发性或复发性 RPS 行 IVC 或 IV 切除术的患者。以总生存率和局部复发及远处转移的粗累积发生率（CCI）评估肿瘤学预后。以并发症、肾功能、下肢水肿和血管移植物通畅性评估手术结果。
共纳入 67 例患者：24 例行 IV 切除术（IV 组），39 例行 IVC 切除术，4 例行 IVC 和 IV 切除术（IVC 组）。最常见的组织学类型为平滑肌肉瘤（63%）和脂肪肉瘤（27%）。5 年总生存率、局部复发 CCI 和远处转移 CCI（95%置信区间）分别为 56.2%（43.6-72.4）、12.4%（5.2-29.5）和 51.5%（39.3-67.5）。38 例 43 例行 IVC 环形切除术的患者中，32 例行移植物重建（22 例行带库静脉同种移植物的间置，10 例行聚四氟乙烯[PTFE]移植物），6 例行单纯结扎，这主要取决于是否存在充足的侧支血管网络。术前存在 IVC 梗阻且仅行结扎术的 6 例患者术后未出现严重下肢水肿。5 年时，IVC-PTFE 移植物的 IVC 移植物一级通畅率为 100%，IVC-BVH 的通畅率为 76.7%。15 例患者（22.4%）在术后 60 天内发生≥3 级 Clavien-Dindo 并发症。
在 RPS 手术中，IVC 或 IV 切除术有助于实现长期生存。对于 IVC 或 IV 环形切除的患者，行血管移植物重建是有价值的。对于 IVC 重建，无论是带库静脉同种移植物还是 PTFE 移植物，在高通畅率和低感染风险方面都能取得良好的效果。
