Department of Visceral, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, Fetscherstr. 74, 01307 Dresden, Germany.
University Center for Orthopedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus, Technische Universitaet Dresden, 01307 Dresden, Germany.
Curr Oncol. 2023 Feb 21;30(3):2555-2568. doi: 10.3390/curroncol30030195.
Malignancies with an extended encasement or infiltration of the aorta were previously considered inoperable. This series demonstrates replacement and subsequent resection of the thoracoabdominal aorta and its large branches as an adjunct to curative radical retroperitoneal and spinal tumor resection. Five consecutive patients were enrolled between 2016 and 2020, suffering from cancer of unknown primary, pleomorphic carcinoma, chordoma, rhabdoid sarcoma, and endometrial cancer metastasis. Wide surgical resection was the only curative option for these patients. For vascular replacement, extracorporeal membrane oxygenation (ECMO) was used as a partial left-heart bypass. The early technical success rate was 100% for vascular procedures and all patients underwent complete radical tumour resection with negative margins. All patients required surgical revision (liquor leak, = 2; hematoma, = 3; bypass revision, = 1; bleeding, = 1; biliary leak, = 1). During follow-up (average 47 months, range 22-70) primary patency rates of aortic reconstructions and arterial bypasses were 100%; no patient suffered from recurrent malignant disease. Thoracoabdominal aortic replacement with rerouting of visceral and renal vessels is feasible in oncologic patients. In highly selected young patients, major vascular surgery can push the limits of oncologic surgery further, allowing a curative approach even in extensive retroperitoneal and spinal malignancies.
先前，被认为有广泛包绕或浸润主动脉的恶性肿瘤是不可手术的。本系列研究展示了胸主动脉腹主动脉及其大分支的置换术和随后的切除术，作为根治性腹膜后和脊柱肿瘤切除术的辅助手段。2016 年至 2020 年期间，连续 5 例患者入组，患有不明原发性癌症、多形性癌、脊索瘤、横纹肌肉瘤和子宫内膜癌转移。对于这些患者，广泛的手术切除是唯一的治愈选择。对于血管置换，体外膜氧合（ECMO）用作部分左心旁路。血管手术的早期技术成功率为 100%，所有患者均接受了完全根治性肿瘤切除术，切缘均为阴性。所有患者均需要手术修正（漏液，=2；血肿，=3；旁路修正，=1；出血，=1；胆漏，=1）。在随访期间（平均 47 个月，范围 22-70），主动脉重建和动脉旁路的主要通畅率为 100%；没有患者出现恶性肿瘤复发。在肿瘤患者中，胸主动脉腹主动脉的替换和内脏及肾脏血管的重新定位是可行的。在高度选择的年轻患者中，主要血管手术可以进一步推动肿瘤手术的极限，即使在广泛的腹膜后和脊柱恶性肿瘤中，也可以采用治愈方法。
