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Sarcoma Resection With and Without Vascular Reconstruction: A Matched Case-Control Study
George A Poultsides*, Thuy B Tran*, David G Mohler*, Matthew W Mell*, Raffi S Avedian*, Brendan C Visser*, Jason T Lee*, Kristen Ganjoo*, E. John Harris*, Jeffrey A Norton
Stanford University Medical Center, Stanford, CA

OBJECTIVE: En bloc resection and reconstruction of involved major vessels is being increasingly performed during sarcoma surgery, however the outcomes of this strategy are not well described.
METHODS: Patients undergoing sarcoma resection with (VASC) and without (NO-VASC) vascular reconstruction were 1:2 matched on site, histology, grade, size, synchronous metastasis, and primary (vs. repeat) resection. R2 resections were excluded. Endpoints included perioperative morbidity, mortality, recurrence, and survival.
RESULTS: From 2000 to 2014, 53 sarcoma patients underwent VASC resection. These were matched with 106 NO-VASC patients having similar clinicopathologic characteristics (Table). Perioperative complications (74% vs. 43%, P<0.001), grade 3/4 complications (36% vs. 19%, P=0.02), transfusion (68% vs. 34%, P<0.001), and reoperation (26% vs. 10%, P=0.018) were all more common in the VASC group. Thirty-day (2% vs. 0%, P=0.33) or 90-day mortality (6% vs. 2%, P=0.19) were not significantly higher. Local recurrence (25% vs. 36%, P=0.19) and survival after resection (5-year, 58% vs. 51%, P=0.56) were similar between the two groups. Within the VASC group, survival after venous only (n=18), arterial and venous (n=19), or arterial only (n=16) reconstruction was comparable (5-year, 72%, 61%, 51%, P=0.33).
CONCLUSIONS: This is the first matched case-control study examining the impact of concomitant vascular reconstruction on sarcoma resection outcomes. These operations are associated with considerable morbidity and require meticulous multidisciplinary planning. However, the oncologic outcome appears equivalent to cases without vascular involvement.
VASC*
Cases
(n=53)
NO-VASC
Controls
(n=106)
P
Age (yrs)57570.69
Female Gender55%54%0.91
SiteRetroperitoneum
Extremity
Trunk
Mediastinum
51%
36%
7%
6%
51%
36%
7%
6%
1
Tumor Size (cm)10.110.10.93
Histologic TypeLeiomyosarcoma
Dediff Liposarcoma
UPS
Synovial Sarcoma
Desmoid
Angiosarcoma
Myxoid Liposarcoma
Well-diff Liposarcoma
Osteosarcoma
Fibromyxoid Sarcoma
Carcinosarcoma
ESS
Chondrosarcoma
PNST
26%
13%
9%
9%
9%
8%
6%
4%
4%
4%
2%
2%
2%
2%
26%
13%
9%
9%
9%
8%
6%
4%
4%
4%
2%
2%
2%
2%
1
Resection TypePrimary
Repeat (for Recurrence)
81%
19%
81%
19%
1
Synchronous Metastasis23%21%0.78
GradeLow
Intermediate
High
28%
21%
51%
28%
17%
55%
0.83
R1 Margin26%28%0.61
UPS, Undifferentiated Pleomorphic Sarcoma; ESS, Endometrial Stromal Sarcoma; PNST, Peripheral Nerve Sheath Tumor
* Overall, 72 vessels were reconstructed in 53 patients: aorta (n=6), vena cava (n=16), iliac artery (n=5), iliac vein (n=5), lower extremity artery (n=17), lower extremity vein (n=13), upper extremity artery (n=4), upper extremity vein (n=2), pulmonary artery (n=2), superior mesenteric artery (n=1), and portal vein (n=1).


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