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Castellanos LD, Tabbara MM, Livingstone AS, Salerno TA, Gonzalez J, Ciancio G. Unresectable leiomyosarcoma of the inferior vena cava with right atrium tumor thrombus: when to deem this tumor inoperable? A case report and literature review. Front Oncol 2024; 13:1331896. [PMID: 38282675 PMCID: PMC10811722 DOI: 10.3389/fonc.2023.1331896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/04/2023] [Indexed: 01/30/2024] Open
Abstract
Leiomyosarcomas (LMS) of the inferior vena cava (IVC) are a rare form of retroperitoneal malignancy, and their venous extension to the right atrium is an even rarer event. These tumors pose a unique surgical challenge and often require a multidisciplinary team-based approach for their surgical treatment. We present a case of a 68-year-old man with primary LMS of the IVC with a tumor thrombus extending into the right atrium that was initially deemed inoperable. After extensive neoadjuvant chemo-radiation with minimal tumor effect, the patient underwent en bloc surgical resection of the tumor along with removal of the infrarenal IVC and right kidney and adrenal without the need for cardiopulmonary bypass. This case demonstrates the successful management of a primary LMS of the IVC with right atrial extension using a multimodal approach of neoadjuvant chemo-radiation and en bloc surgical resection without cardiopulmonary bypass. This strategy may offer a curative option for selected patients with these rare and aggressive tumors, improving their survival and quality of life.
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Affiliation(s)
- Luis D. Castellanos
- Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
| | - Marina M. Tabbara
- Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
| | - Alan S. Livingstone
- Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
- Division of Surgical Oncology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Tomas A. Salerno
- Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
- Division of Cardiothoracic Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Javier Gonzalez
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gaetano Ciancio
- Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
- Department of Urology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
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Resection of Primary Renal Leiomyosarcoma Involving the Inferior Vena Cava (IVC) with IVC Resection and Reconstruction. Case Rep Surg 2022; 2022:6037890. [PMID: 35719719 PMCID: PMC9200563 DOI: 10.1155/2022/6037890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/17/2022] [Indexed: 11/24/2022] Open
Abstract
Renal leiomyosarcoma is a rare, aggressive tumor of the smooth muscles of the kidney. In our case, the tumor has special characteristics that made it highly challenging, as it involved major vessels and other adjacent vital structures. The rarity of the tumor type itself and the special challenging features we faced intraoperatively encouraged us to report the case including the management plan for R0 resection. Our patient is a forty-two years old previously healthy female, with vague nonspecific presenting complains, ended up with a major highly advanced surgery necessitating the need for vascular reconstruction of IVC. The surgery was performed by a multidisciplinary team of highly specialized surgeons in related fields. The surgery went well, and the outcome was promising. The patient was followed up for about four months later, with uneventful course.
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Borghese O, Pisani A, Dubrez J, Di Centa I. Treatment outlines for the management of primary leiomyosarcoma of the inferior vena cava. JOURNAL DE MEDECINE VASCULAIRE 2022; 47:65-70. [PMID: 35691665 DOI: 10.1016/j.jdmv.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/26/2022] [Indexed: 06/15/2023]
Abstract
Primary venous Leiomyosarcoma (LMSs) are extremely rare tumours with poor survival rates. Surgery is currently the only potentially curative therapy in non-metastatic disease, but it consists in challenging interventions. The authors report the experience of one single centre in the treatment of LMS and a literature overview focusing on the diverse methods of vessels repair. Outcomes achieved are also outlined.
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Affiliation(s)
- Ottavia Borghese
- Sapienza University, Rome, Italy; Department of Vascular and Endovascular Surgery, Foch Hospital, Suresnes, France.
| | - Angelo Pisani
- Sapienza University, Rome, Italy; Department of Cardiovascular Surgery, Azienda Ospedaliera Santa Maria della Misericordia, Perugia, Italy
| | - Julien Dubrez
- Department of Gastrointestinal Surgery, Foch Hospital, Suresnes, France
| | - Isabelle Di Centa
- Department of Vascular and Endovascular Surgery, Foch Hospital, Suresnes, France
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Kotsis T, Christoforou P, Polydorou A. The contribution of oncovascular surgery in a young patient with idiopathic retroperitoneal fibrosis. J Surg Case Rep 2022; 2022:rjab589. [PMID: 35047174 PMCID: PMC8763601 DOI: 10.1093/jscr/rjab589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 12/03/2021] [Indexed: 11/23/2022] Open
Abstract
Surgical resection remains the cornerstone for the treatment of oncological disease. When a critical arterial or venous structure is involved in a tumor mass, successful relief of symptoms and long-term oncological control are achieved through careful preoperative planning by an interdisciplinary team that necessarily includes a vascular surgeon. We describe the involvement of a vascular surgeon in the oncology of a 22-year-old woman, who is diagnosed with idiopathic retroperitoneal fibrosis.
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Affiliation(s)
- Thomas Kotsis
- Vascular Division, 2nd Clinic of Surgery, National & Kapodistrian University of Athens Medical School, “ARETAIEION” Hospital, Athens, Greece
| | - Panagitsa Christoforou
- Vascular Division, 2nd Clinic of Surgery, National & Kapodistrian University of Athens Medical School, “ARETAIEION” Hospital, Athens, Greece
| | - Andreas Polydorou
- 2nd Clinic of Surgery, National & Kapodistrian University of Athens Medical School, “ARETAIEION” Hospital, Athens, Greece
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Bacalbasa N, Balescu I, Ichim F, Barbu I, Ristea A, Lazea R, Danciuc I, Popa I, Magdoiu O, Smira G, Diaconu C, Furtunescu F, Stiru O, Savu C, Stoica C, Brasoveanu V, Ursut B, Al Aloul A. Major Hepatectomy En Bloc with Cava Vein Resection for Locally Invasive Caudate Lobe Hepatocarcinoma. Healthcare (Basel) 2021; 9:healthcare9101396. [PMID: 34683076 PMCID: PMC8535728 DOI: 10.3390/healthcare9101396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND/AIM Locally advanced liver tumours with vascular invasion have been considered for a long period of time as unresectable lesions, so the patient was further deferred to oncology services for palliation. However, improvement of the surgical techniques and the results reported so far came to demonstrate that extended hepatic and vascular resections might be safely performed in such cases and might significantly improve the long-term outcomes. MATERIALS AND METHODS A 61-year-old patient was diagnosed with a caudate lobe tumour invading the inferior cava vein and the right hepatic pedicle. RESULTS The patient was successfully submitted to surgery, and an extended right hepatectomy en bloc with cava vein resection was performed; the continuity of the cava vein was re-established by the placement of a synthetic graft. The postoperative outcome was uneventful. CONCLUSIONS Although initially considered as a formal contraindication for resection, vascular invasion of the greater vessels should not preclude surgery if complete resection is achievable.
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Affiliation(s)
- Nicolae Bacalbasa
- Department of Visceral Surgery, Center of Excellence in Translational Medicine “Fundeni” Clinical Institute, 022328 Bucharest, Romania; (F.I.); (I.B.); (A.R.); (R.L.); (I.D.); (I.P.); (O.M.); (V.B.)
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Correspondence: ; Tel.: +40-723540426
| | - Irina Balescu
- Department of Surgery, “Ponderas” Academic Hospital, 014142 Bucharest, Romania;
| | - Florin Ichim
- Department of Visceral Surgery, Center of Excellence in Translational Medicine “Fundeni” Clinical Institute, 022328 Bucharest, Romania; (F.I.); (I.B.); (A.R.); (R.L.); (I.D.); (I.P.); (O.M.); (V.B.)
| | - Ion Barbu
- Department of Visceral Surgery, Center of Excellence in Translational Medicine “Fundeni” Clinical Institute, 022328 Bucharest, Romania; (F.I.); (I.B.); (A.R.); (R.L.); (I.D.); (I.P.); (O.M.); (V.B.)
| | - Alexandru Ristea
- Department of Visceral Surgery, Center of Excellence in Translational Medicine “Fundeni” Clinical Institute, 022328 Bucharest, Romania; (F.I.); (I.B.); (A.R.); (R.L.); (I.D.); (I.P.); (O.M.); (V.B.)
| | - Razvan Lazea
- Department of Visceral Surgery, Center of Excellence in Translational Medicine “Fundeni” Clinical Institute, 022328 Bucharest, Romania; (F.I.); (I.B.); (A.R.); (R.L.); (I.D.); (I.P.); (O.M.); (V.B.)
| | - Ioana Danciuc
- Department of Visceral Surgery, Center of Excellence in Translational Medicine “Fundeni” Clinical Institute, 022328 Bucharest, Romania; (F.I.); (I.B.); (A.R.); (R.L.); (I.D.); (I.P.); (O.M.); (V.B.)
| | - Ioana Popa
- Department of Visceral Surgery, Center of Excellence in Translational Medicine “Fundeni” Clinical Institute, 022328 Bucharest, Romania; (F.I.); (I.B.); (A.R.); (R.L.); (I.D.); (I.P.); (O.M.); (V.B.)
| | - Ovidiu Magdoiu
- Department of Visceral Surgery, Center of Excellence in Translational Medicine “Fundeni” Clinical Institute, 022328 Bucharest, Romania; (F.I.); (I.B.); (A.R.); (R.L.); (I.D.); (I.P.); (O.M.); (V.B.)
| | - Gabriela Smira
- Department of Gastroenterology, “Fundeni” Clinical Institute, 022328 Bucharest, Romania;
| | - Camelia Diaconu
- Department of Internal Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Florentina Furtunescu
- Department of Public Health and Management, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania;
| | - Ovidiu Stiru
- Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania;
- Department of Cardio-Thoracic Pathology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Cornel Savu
- Department of Thoracic Surgery, “Marius Nasta” National Institute of Pneumology, 050159 Bucharest, Romania;
- Department of Thoracic Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Claudia Stoica
- Department of Surgery, Ilfov County Hospital, 077160 Bucharest, Romania;
- Department of Anatomy, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Vladislav Brasoveanu
- Department of Visceral Surgery, Center of Excellence in Translational Medicine “Fundeni” Clinical Institute, 022328 Bucharest, Romania; (F.I.); (I.B.); (A.R.); (R.L.); (I.D.); (I.P.); (O.M.); (V.B.)
| | - Bogdan Ursut
- Department of Anatomy, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Surgery, Emergency Hospital “Agrippa Ionescu”, 011356 Bucharest, Romania
| | - Adnan Al Aloul
- Department of Surgery, Ramnicu Sarat County Hospital, 125300 Buzau, Romania;
- Facullty of Medicine, “Titu Maiorescu” University of Medicine and Pharmacy, 031593 Bucharest, Romania
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Brasoveanu V, Barbu I, Balescu I, Bacalbasa N, Cordos I. Infra-hepatic caval resection en bloc with right nephrectomy followed by caval reconstruction for locally advanced caval leiomyosarcoma: A case report and literature review. Exp Ther Med 2021; 22:1377. [PMID: 34650625 DOI: 10.3892/etm.2021.10812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/16/2021] [Indexed: 11/06/2022] Open
Abstract
Retroperitoneal sarcomas often require complex surgical procedures in order to achieve complete resection; in such cases both vascular and visceral resections are needed. When it comes to the need for vascular reconstruction, the type of graft as well as the type of reconstructive process are chosen according to the length and location of the resected segment. Meanwhile, depending on the location of the resected segment, other vascular reconstructions may be needed such as the reimplantation of the renal veins. However, in certain cases, this reimplantation is not mandatory, an adequate renal outflow being reported through the collateral network at this level. We present the case of a 43-year-old patient diagnosed with a large retroperitoneal sarcoma originating from the cava vein invading the right kidney. Resection of the tumor was performed en bloc with caval resection and right nephrectomy, without reimplantation of the left renal vein at the level of the graft. Extended visceral and vascular resections might be needed in order to achieve complete resection of inferior cava vein sarcomas; re-implantation of the left renal vein being not mandatory if rich collateral circulation is present.
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Affiliation(s)
- Vladislav Brasoveanu
- Department of Visceral Surgery, 'Dan Setlacec' Center of Gastrointestinal Diseases and Liver Transplantation, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania.,Department of Surgery, 'Titu Maiorescu' University of Medicine and Pharmacy, 040051 Bucharest, Romania
| | - Ion Barbu
- Department of Visceral Surgery, 'Dan Setlacec' Center of Gastrointestinal Diseases and Liver Transplantation, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Irina Balescu
- Department of Surgery, 'Ponderas' Academic Hospital, 021188 Bucharest, Romania
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Visceral Surgery, Center of Excellence in Translational Medicine 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Ioan Cordos
- Department of Thoracic Surgery, 'Marius Nasta' National Institute of Pneumology, 050159 Bucharest, Romania.,Department of Thoracic Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Aleshawi AJ, Allouh MZ, Heis FH, Tashtush N, Heis HA. Primary Leiomyosarcoma of the Pancreas: a Comprehensive Analytical Review. J Gastrointest Cancer 2021; 51:433-438. [PMID: 31392629 DOI: 10.1007/s12029-019-00282-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Primary leiomyosarcoma of the pancreas (PLMSP) is rare. The clinical features and outcomes are still unclear. The present study aims to identify the clinical features, outcomes, and racial differences of PLMSP. METHODS PLMSP cases reported in Chinese, English, French, and Japanese journals were collected and reviewed. Data from these reports were summarized and analyzed statistically. RESULTS In addition to a female patient presented to our department with PLMS, a total of 87 cases reported in the literature were included in the present study. An equal incidence in gender was observed. The mean age was 53.8 years. Common symptoms were abdominal pain and abdominal mass. At the time of diagnosis or after a period of follow-up, 37.5% of patients had distant metastasis and 31.8% of patients had regional organs/vessels invasion. The 5-year mortality rate was 77.8%. The presence of distant metastasis and the absence of radical surgery are significantly associated with poor outcomes. Regional invasion was significantly more common in East Asians. CONCLUSION PLMSP is an aggressive tumor with a poor prognosis. Radical resection can decrease the mortality of the patients. Early detection of such tumor is recommended.
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Affiliation(s)
- Abdelwahab J Aleshawi
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, P. O. Box: 3030, Irbid, 22110, Jordan.
| | - Mohammed Z Allouh
- Department of Anatomy, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
- Department of Anatomy, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, 17666, United Arab Emirates
| | - Farah H Heis
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, P. O. Box: 3030, Irbid, 22110, Jordan
| | - Nour Tashtush
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, P. O. Box: 3030, Irbid, 22110, Jordan
| | - Hussein A Heis
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science & Technology, P. O. Box: 3030, Irbid, 22110, Jordan
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Homsy P, Blomqvist C, Heiskanen I, Vikatmaa L, Tukiainen E, Numminen K, Sampo M, Leppäniemi A, Albäck A, Kantonen I, Vikatmaa P. Multidisciplinary Oncovascular Surgery is Safe and Effective in the Treatment of Intra-abdominal and Retroperitoneal Sarcomas: A Retrospective Single Centre Cohort Study and a Comprehensive Literature Review. Eur J Vasc Endovasc Surg 2020; 60:752-763. [DOI: 10.1016/j.ejvs.2020.05.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 04/23/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022]
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Operative strategies for inferior vena cava repair in oncologic surgery. J Vasc Surg Venous Lymphat Disord 2019; 8:396-404. [PMID: 31843478 DOI: 10.1016/j.jvsv.2019.09.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 09/21/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Tumor involvement of the inferior vena cava (IVC) can result from primary caval leiomyosarcoma, local invasion by retroperitoneal malignant neoplasm, or metastases. Whereas ligation of the IVC may be well tolerated if collateral circulation can be adequately preserved, collaterals must often be ligated during oncologic resection. Reconstruction of the IVC may be performed by primary repair, patch angioplasty, or interposition graft. The purpose of our study was to describe different strategies of IVC reconstruction and to measure outcomes associated with IVC reconstruction among patients with retroperitoneal malignant disease. METHODS All patients undergoing IVC reconstruction at our quaternary care hospital between November 2004 and February 2018 were identified using billing data (Current Procedural Terminology code 34502). Patients who underwent resection of the IVC for tumor involvement were enrolled in our study; data were collected on demographics, operative intervention, type of reconstruction, postoperative course, and 1-year outcomes. Patency rates were assessed by reviewing postoperative imaging including computed tomography, magnetic resonance imaging, ultrasound, and venography. Two-year mortality and patency were calculated using Kaplan-Meier analysis methods. RESULTS We identified 52 (46% female) patients who underwent IVC reconstruction for retroperitoneal malignant disease. The mean age was 53.6 years (range, 23-80 years). Procedures performed included primary repair (n = 17 [33%]), patch angioplasty (n = 18 [35%]), and interposition grafting (n = 17 [33%]). The mean length of stay was 16 days and did not vary significantly by group. Patients undergoing interposition graft were discharged on aspirin 81 mg daily. The 30-day survival rate was 96.2% (95% confidence interval [CI], 90.9-100), 1-year survival rate was 75.1% (95% CI, 62.8-87.4), and 2-year survival rate was 64.7% (95% CI, 50.5-78.9). There were no intraoperative deaths. The 30-day primary patency rate was 96% (95% CI, 90.7-100.0), 1-year primary patency rate was 88.8% (95% CI, 79.4-98.2), and 2-year primary patency rate was 77.5% (95% CI, 63.0-92.0). Seven patients (14%) developed nonocclusive thrombus within the IVC, and 16 patients (30%) developed postoperative symptoms of venous obstruction. CONCLUSIONS IVC reconstruction is a safe option for patients requiring IVC resection during oncologic surgery as evidenced by 1-year survival of 75% and 1-year primary patency approaching 90%. The overall rate of postoperative thrombus development was low and similar across all groups. In the management of primary and secondary retroperitoneal malignant disease with IVC infiltration, IVC reconstruction should be considered to achieve appropriate oncologic resection while minimizing possible complications from caval interruption.
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Mastoraki A, Schizas D, Papanikolaou IS, Bagias G, Machairas N, Agrogiannis G, Liakakos T, Arkadopoulos N. Management of primary retroperitoneal synovial sarcoma: A case report and review of literature. World J Gastrointest Surg 2019; 11:27-33. [PMID: 30705737 PMCID: PMC6354068 DOI: 10.4240/wjgs.v11.i1.27] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/11/2018] [Accepted: 12/30/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Synovial sarcoma (SS) is a rare type of soft tissue sarcoma that is usually developed from areas where synovial tissue exists, especially at the extremities. Nevertheless, several cases of retroperitoneal SS (RSS) have been described. We herein report a case of RSS presented in our institution.
CASE SUMMARY A 69-year-old female patient was admitted with a large, palpable, firm mass in the right abdominal space SS. Computerized tomography scan depicted a concentric, sharply marinated retro-peritoneal lesion which was displacing the right kidney and the lower edge of the liver. Subsequently, the patient underwent surgical excision of the mass with additional right nephrectomy and resection of the right adrenal gland and a part of the diaphragm. The final histological diagnosis of the tumour was grade II monophasic RSS.
CONCLUSION RSS is encountered in the biphasic type, the monophasic fibrous, and the monophasic epithelial category as well. Relevant clinical manifestations are not always documented at early stages. Therefore, the final diagnosis is posed after complete histological examination taking into consideration the results of immunochemistry and genetic analysis. Therapeutic approach happens often late when metastases at the lungs and the liver are apparent. Thus, 5-year survival rates remain low.
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Affiliation(s)
- Aikaterini Mastoraki
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens 12462, Greece
| | - Dimitrios Schizas
- 1st Department of Surgery, National and Kapodistrian University of Athens, Laikon Hospital, Athens 11527, Greece
| | - Ioannis S Papanikolaou
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens 12462, Greece
| | - George Bagias
- Hannover Medical School, Clinic for General, Visceral and Transplant Surgery, Hannover 30625, Germany
| | - Nikolaos Machairas
- 3rd Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens 12462, Greece
| | - George Agrogiannis
- 1st Department of Pathology, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Theodore Liakakos
- 1st Department of Surgery, National and Kapodistrian University of Athens, Laikon Hospital, Athens 11527, Greece
| | - Nikolaos Arkadopoulos
- 4th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Athens 12462, Greece
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Theodoraki K, Kostopanagiotou K, Theodosopoulos T, Vassiliu P, Kizgala P, Parasyris S, Bouzalas D, Arkadopoulos N, Smyrniotis V. Resection of abdominal inferior vena cava without graft interposition: Considerations in preserving renal function. J Surg Oncol 2018; 118:704-708. [PMID: 30079542 DOI: 10.1002/jso.25191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/11/2018] [Indexed: 11/10/2022]
Abstract
The management of tumors involving or infiltrating the inferior vena cava (IVC) constitutes a great surgical challenge, since radical resection affords patients the only possibility for long-term survival. These tumors can be resected without graft interposition, provided that there is adequate collateral circulation and that the renal function can be secured. Meanwhile, ligation of the left renal vein may be possible due to the existence of collateral circulation through the adrenal and gonadal veins. We briefly present our experience on renal outflow preservation through implantation of the right renal vein into the IVC stump or through diversion of the left renal vein into the inferior mesenteric vein.
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Affiliation(s)
- Kassiani Theodoraki
- Department of Anesthesiology, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Kostopanagiotou
- Fourth Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodosios Theodosopoulos
- Second Department of Surgery, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Pantelis Vassiliu
- Fourth Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Polyxeni Kizgala
- Fourth Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavros Parasyris
- Fourth Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dionysios Bouzalas
- Fourth Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Arkadopoulos
- Fourth Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassilios Smyrniotis
- Fourth Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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12
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Ghose J, Bhamre R, Mehta N, Desouza A, Patkar S, Dhareshwar J, Goel M, Shrikhande SV. Resection of the Inferior Vena Cava for Retroperitoneal Sarcoma: Six Cases and a Review of Literature. Indian J Surg Oncol 2018; 9:538-546. [PMID: 30538385 DOI: 10.1007/s13193-018-0796-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 07/13/2018] [Indexed: 12/20/2022] Open
Abstract
Resection of the inferior vena cava (IVC) for malignancy is a technically demanding procedure. We present a series of six cases of resection of the IVC for retroperitoneal sarcomas, four of which were primary caval tumors. We outline the technical difficulties faced in these complex procedures and discuss the oncological outcomes of these rare tumors. We performed a retrospective review of six patients operated for retroperitoneal masses involving the inferior vena cava between April 2015 and July 2016 at our tertiary care institute. Six patients underwent resection of the IVC, three of which required a multivisceral resection. An artificial prosthesis was used to reconstruct the IVC in three patients, whereas two patients underwent primary repair of the vein wall. One patient did not require any reconstruction. Margins were microscopically positive in two out of six patients. All patients received radiotherapy, either in the neo-adjuvant or adjuvant setting. Two patients developed local recurrences with a median follow-up of 24.5 months. Resection of the IVC for extirpation of retroperitoneal sarcomas is a technically complex and difficult procedure. The availability of a multidisciplinary team of surgeons and state-of-the-art intensive care support is essential for good outcomes.
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Affiliation(s)
- Joy Ghose
- 1Gastrointestinal Surgical Oncology, Department of Surgical Oncology and HPB services, Tata Memorial Hospital, Dr. E Borges Rd., Parel (E), Mumbai, 400012 India
| | - Rahul Bhamre
- 1Gastrointestinal Surgical Oncology, Department of Surgical Oncology and HPB services, Tata Memorial Hospital, Dr. E Borges Rd., Parel (E), Mumbai, 400012 India
| | - Nikhil Mehta
- 1Gastrointestinal Surgical Oncology, Department of Surgical Oncology and HPB services, Tata Memorial Hospital, Dr. E Borges Rd., Parel (E), Mumbai, 400012 India
| | - Ashwin Desouza
- 1Gastrointestinal Surgical Oncology, Department of Surgical Oncology and HPB services, Tata Memorial Hospital, Dr. E Borges Rd., Parel (E), Mumbai, 400012 India
| | - Shraddha Patkar
- 1Gastrointestinal Surgical Oncology, Department of Surgical Oncology and HPB services, Tata Memorial Hospital, Dr. E Borges Rd., Parel (E), Mumbai, 400012 India
| | - Jayesh Dhareshwar
- 2Cardiovascular Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Dr. E Borges Rd., Parel (E), Mumbai, 400012 India
| | - Mahesh Goel
- 1Gastrointestinal Surgical Oncology, Department of Surgical Oncology and HPB services, Tata Memorial Hospital, Dr. E Borges Rd., Parel (E), Mumbai, 400012 India
| | - Shailesh V Shrikhande
- 1Gastrointestinal Surgical Oncology, Department of Surgical Oncology and HPB services, Tata Memorial Hospital, Dr. E Borges Rd., Parel (E), Mumbai, 400012 India
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13
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Fujita S, Takahashi H, Kanzaki Y, Fujisaka T, Takeda Y, Ozawa H, Kuwabara H, Katsumata T, Ishizaka N. Primary Leiomyosarcoma in the Inferior Vena Cava Extended to the Right Atrium: A Case Report and Review of the Literature. Case Rep Oncol 2016; 9:599-609. [PMID: 27920691 PMCID: PMC5118828 DOI: 10.1159/000450598] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/06/2016] [Indexed: 12/12/2022] Open
Abstract
A 38-year-old woman had developed an abdominal distention, lower extremity edema, and dyspnea. Imaging examination revealed a large mass in the right atrium which was connected to lesions within the inferior vena cava. Although complete resection of the mass was not possible, partial surgical tumor resection was performed to avoid pulmonary embolization and circulatory collapse. Leiomyosarcoma was diagnosed histologically, and chemotherapy (doxorubicin) followed by radiotherapy was started. By reviewing papers published in the past 10 years that included 322 patients, we also discuss the clinical presentations and prognosis of leiomyosarcoma in the inferior vena cava.
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Affiliation(s)
- Shuichi Fujita
- Department of Cardiology, Osaka Medical College, Osaka, Japan
| | | | - Yumiko Kanzaki
- Department of Cardiology, Osaka Medical College, Osaka, Japan
| | | | | | - Hideki Ozawa
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Osaka, Japan
| | | | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Osaka, Japan
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Leiomyosarcoma of the Inferior Vena Cava: A Case Series and Review of the Literature. Ann Vasc Surg 2016; 33:245-51. [DOI: 10.1016/j.avsg.2015.10.016] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/04/2015] [Accepted: 10/15/2015] [Indexed: 12/20/2022]
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15
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Technical risk factors for portal vein reconstruction thrombosis in pancreatic resection. J Vasc Surg 2015; 62:424-33. [PMID: 25953018 DOI: 10.1016/j.jvs.2015.01.061] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/22/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Vascular reconstruction can facilitate pancreas tumor resection, but optimal methods of reconstruction are not well studied. We report our results for portal vein reconstruction (PVR) for pancreatic resection and determinants of postoperative patency. METHODS We identified 173 patients with PVR in a prospective database of 6522 patients who underwent pancreatic resection at our hospital from 1970 to 2014. There were 128 patients who had >1 year of follow-up with computed tomography imaging. Preoperative, intraoperative, and postoperative factors were recorded. Patients with and without postoperative PVR thrombosis were compared by univariable, multivariable, and receiver operating characteristic curve analyses. RESULTS The survival of patients was 100% at 1 month, 88% at 6 months, 66% at 1 year, and 39% on overall median follow-up of 310 days (interquartile range, 417 days). Median survival was 15.5 months (interquartile range, 25 months); 86% of resections were for cancer. Four types of PVR techniques were used: 83% of PVRs were performed by primary repair, 8.7% with interposition vein graft, 4.7% with interposition prosthetic graft, and 4.7% with patch. PVR patency was 100% at 1 day, 98% at 1 month, 91% at 6 months, and 83% at 1 year. Patients with PVR thrombosis were not significantly different from patients with patent PVR in age, survival, preoperative comorbidities, tumor characteristics, perioperative blood loss or transfusion, or postoperative complications. They were more likely to have had preoperative chemotherapy (53% vs 9%; P < .0001), radiation therapy (35% vs 2%; P < .0001), and prolonged operative time (618 ± 57 vs 424 ± 20 minutes; P = .002) and to develop postoperative ascites (76% vs 22%; P < .001). Among patients who developed ascites, 38% of those with PVR thrombosis did so in the setting of tumor recurrence at the porta detected on imaging, whereas among patients with patent PVR, 50% did so (P = .73). Patients with PVR thrombosis were more likely to have had prosthetic graft placement compared with patients with patent PVRs (18% vs 2.7%; P = .03; odds ratio [OR], 7.7; 95% confidence interval [CI], 1.4-42). PVR patency overall was significantly worse for patients who had an interposition prosthetic graft reconstruction (log-rank, P = .04). On multivariable analysis, operative time (OR, 1.01; 95% CI, 1.01-1.02) and prosthetic graft placement (OR, 8.12; 95% CI, 1.1-74) were independent predictors of PVR thrombosis (C statistic = 0.88). CONCLUSIONS Long operative times and use of prosthetic grafts for reconstruction are risk factors for postoperative portal vein thrombosis. Primary repair, patch, or vein interposition should be preferentially used for PVR in the setting of pancreatic resection.
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Mateo Vallejo F, Dominguez Reinado MR, Medina Achirica C, Diaz Oteros M, Esteban Ramos JL, Melero Brenes S. Giant retroperitoneal leiomyosarcoma. Multiorgan block removal. Int J Surg Case Rep 2014; 5:1050-3. [PMID: 25460472 PMCID: PMC4275809 DOI: 10.1016/j.ijscr.2014.10.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 09/12/2014] [Accepted: 10/15/2014] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Retroperitoneal tumors are rare, mostly malignant. Locally aggressive, and more frequent in women in their 5th decade of life. Its symptoms are nonspecific, including abdominal pain and palpable mass. To diagnosis is helpful computed tomography and biopsy. It needs surgery for absolute healing. PRESENTATION OF CASE 67 years old man was admitted with back pain and fever. Abdominal imaging tests showed a 15cm abdominal mass without clear organodependencia. Endoscopy with biopsies evidenced mesenchymal neoplasia of undetermined origin. In surgery we confirm its resecability and was necessary multiorgan resection. Pathologic diagnosis: well differentiated retroperitoneal leiomyosarcoma. Started adjuvant radiotherapy. In subsequent tests showed the presence of liver metastases. DISCUSSION Retroperitoneal tumors are developed from nerve, vascular, muscular, connective, supportive and fibroareolar tissue from this space. Its size does not modificate survival or resectability. We used TC and biopsy for its diagnose. Adjuvant therapy does not affect survival or quality of life, surgery remains the only curative option. Locoregional recurrence is the most influential figure in the prognosis. A large percentage of patients required a second surgery (between 45 and 82%). CONCLUSION The only curative option of retroperitoneal sarcomas is surgery, which usually requires multiple organ resection. Chemotherapy and radiotherapy are mostly a surgical supplement. Chemotherapy has not shown significant increase in survival.
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Affiliation(s)
- F Mateo Vallejo
- Hospital of Jerez de la Frontera, N-IVa Road s/n, Jerez, Cadiz, Spain.
| | | | - C Medina Achirica
- Hospital of Jerez de la Frontera, N-IVa Road s/n, Jerez, Cadiz, Spain
| | - M Diaz Oteros
- Hospital of Jerez de la Frontera, N-IVa Road s/n, Jerez, Cadiz, Spain
| | - J L Esteban Ramos
- Hospital of Jerez de la Frontera, N-IVa Road s/n, Jerez, Cadiz, Spain
| | - S Melero Brenes
- Hospital of Jerez de la Frontera, N-IVa Road s/n, Jerez, Cadiz, Spain
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Pulitanó C, Crawford M, Ho P, Gallagher J, Joseph D, Stephen M, Sandroussi C. The use of biological grafts for reconstruction of the inferior vena cava is a safe and valid alternative: results in 32 patients in a single institution. HPB (Oxford) 2013; 15:628-32. [PMID: 23458108 PMCID: PMC3731585 DOI: 10.1111/hpb.12029] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 10/17/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Resection and reconstruction of the inferior vena cava (IVC) is occasionally required in the surgical treatment of intra-abdominal tumours. IVC reconstruction can be performed with biological or synthetic graft material, with most centres preferring synthetic grafts. In spite of the potential advantages of biological grafts in terms of handling characteristics, and safety, very limited data are available about their use in patients requiring an IVC resection. METHODS Medical records of 32 patients who underwent an IVC resection and reconstruction from 1990 and 2011 with autogenous peritoneo-fascial (N = 22) and bovine pericardial (N = 10) grafts were reviewed. RESULTS A tangential resection with patch repair was performed in 10 patients, whereas in the remaining 22 it was necessary to resect and replace a segment or all of the retrohepatic IVC. A concomitant liver resection was performed in 14 patients, nephrectomy in 10 and pancreaticoduodenectomy in 2 patients. There were no acute or late complications related to graft thrombosis or infection. Three patients died as a consequence of multi-organ failure. Overall survival at 1 and 5 years was 78% and 48%, respectively. CONCLUSIONS The preferential use of synthetic grafts in IVC replacement is not evidence based. Selection of an appropriate prosthetic graft for IVC reconstruction should be based on the safety and its handling features. The use of biological grafts for IVC repair is a valid alternative to current synthetic materials and may in fact be superior in terms of biocompatability, ease of handling, reduced rate of infection and improved long-term patency without permanent anticoagulation.
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Affiliation(s)
- Carlo Pulitanó
- Upper Gastrointestinal and Hepatobiliary Surgery. Royal Prince Alfred HospitalSydney, NSW, Australia
| | - Michael Crawford
- Upper Gastrointestinal and Hepatobiliary Surgery. Royal Prince Alfred HospitalSydney, NSW, Australia
| | - Phong Ho
- Upper Gastrointestinal and Hepatobiliary Surgery. Royal Prince Alfred HospitalSydney, NSW, Australia
| | - James Gallagher
- Upper Gastrointestinal and Hepatobiliary Surgery. Royal Prince Alfred HospitalSydney, NSW, Australia
| | - David Joseph
- Upper Gastrointestinal and Hepatobiliary Surgery. Royal Prince Alfred HospitalSydney, NSW, Australia
| | - Michael Stephen
- Upper Gastrointestinal and Hepatobiliary Surgery. Royal Prince Alfred HospitalSydney, NSW, Australia
| | - Charbel Sandroussi
- Upper Gastrointestinal and Hepatobiliary Surgery. Royal Prince Alfred HospitalSydney, NSW, Australia,University of Sydney, Surgical Outcomes Research Centre (SOurCe)Sydney, NSW, Australia
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Padilla-Fernandez B, Lorenzo-Gomez MF, Herrero-Polo M, Silva-Abuin JM, Martin-Izquierdo M, Antunez-Plaza P. Leiomyosarcoma of the inferior vena cava in a patient with double inferior vena cava. Ann Vasc Surg 2012; 26:859.e1-5. [PMID: 22717359 DOI: 10.1016/j.avsg.2011.11.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Revised: 07/03/2011] [Accepted: 11/04/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Leiomyosarcoma of the inferior vena cava (IVC) is a rare tumor arising from its smooth muscle cells. METHODS AND RESULTS We report the case of a 38-year-old woman presenting with back pain and weight loss who was diagnosed with a 22-cm leiomyosarcoma of the right IVC and thrombosis of the left IVC. The patient is alive and free of recurrence a year after radical tumor resection with removal of the affected IVC, reconstruction with polytetrafluoroethylene prosthetic graft, and anastomosis of both right and left IVC. CONCLUSIONS Leiomyosarcoma is a rare and aggressive tumor with a deceitful course. Radical surgical en bloc resection is the mainstay of treatment for IVC leiomyosarcomas. For an adequate restoration of venous return, complex vascular repair may be necessary.
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Carvajal López F, García Domingo MI, Herrero Fonollosa E, Camps Lasa J, Cugat Andorrà E. [Inferior vena cava leiomyosarcoma with liver metastasis. Multi-organ resection with vascular reconstruction]. Cir Esp 2012; 91:394-5. [PMID: 22607907 DOI: 10.1016/j.ciresp.2012.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Accepted: 02/15/2012] [Indexed: 10/28/2022]
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20
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Mullinax JE, Zager JS, Gonzalez RJ. Current diagnosis and management of retroperitoneal sarcoma. Cancer Control 2011; 18:177-87. [PMID: 21666580 DOI: 10.1177/107327481101800305] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Retroperitoneal sarcomas are rare neoplasms that often present with multivisceral involvement. Treatment for these tumors requires careful decision making requiring a combination of surgery, chemotherapy, and radiation therapy. METHODS We reviewed the scientific literature pertaining to the diagnosis and management of retroperitoneal sarcomas. We also identify recent developments in treatment and discuss future trends in the care of patients with this disease. RESULTS Retroperitoneal tumors often present as large, locally advanced lesions. Evaluation of these tumors requires careful consideration of a multimodality approach. Retrospective data and historical prospective series have demonstrated the survival benefit of radical resection for these tumors with en bloc resection of involved structures. Compartmental resections in the retroperitoneum along with debulking of high-grade disease and regional therapy are controversial approaches with significant morbidity that can lead to long-term survival. The application of neoadjuvant and adjuvant therapies in select tumor histologies may improve local control and survival. CONCLUSIONS The management of retroperitoneal sarcomas requires a multidisciplinary approach and is best accomplished at high-volume centers specializing in the care of patients with these complex malignancies. Current data suggest that radical resection remains the only chance for cure and that chemotherapy and radiation therapy may confer a survival benefit.
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Affiliation(s)
- John E Mullinax
- Department of Surgery at The University of South Florida College of Medicine, Tampa, Florida, USA
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21
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Kyriazi MA, Stafyla VK, Chatzinikolaou I, Koureas A, Chatziioannou A, Kondi-Paphiti A, Arkadopoulos N, Smyrniotis V. Surgical Challenges in the Treatment of Leiomyosarcoma of the Inferior Vena Cava: Analysis of Two Cases and Brief Review of the Literature. Ann Vasc Surg 2010; 24:826.e13-7. [DOI: 10.1016/j.avsg.2010.02.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 11/03/2009] [Accepted: 02/18/2010] [Indexed: 10/19/2022]
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22
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Chu CK, Farnell MB, Nguyen JH, Stauffer JA, Kooby DA, Sclabas GM, Sarmiento JM. Prosthetic graft reconstruction after portal vein resection in pancreaticoduodenectomy: a multicenter analysis. J Am Coll Surg 2010; 211:316-24. [PMID: 20800187 DOI: 10.1016/j.jamcollsurg.2010.04.005] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 03/18/2010] [Accepted: 04/08/2010] [Indexed: 12/21/2022]
Abstract
BACKGROUND Use of prosthetic grafts for reconstruction after portal vein (PV) resection during pancreaticoduodenectomy is controversial. We examined outcomes in patients who underwent vein reconstruction using polytetrafluoroethylene (PTFE). STUDY DESIGN Review of prospectively maintained databases at 3 centers identified all patients who underwent pancreaticoduodenectomy (PD) with vein resection and reconstruction using PTFE grafts between 1994 and 2009. Patient, operative, and outcomes variables were studied. Graft patency and survival were assessed using the Kaplan-Meier technique. RESULTS Thirty-three patients underwent segmental vein resection with interposition PTFE graft reconstruction. Median age was 67 years; median Eastern Cooperative Oncology Group score was 1. Most operations were performed for pancreatic adenocarcinoma (n = 28, 85%); 96% were T3 lesions or greater. Standard PD was performed in 12 (36%) patients, pylorus-preservation in 17 (52%), and total pancreatectomy in 4 (12%). Combined resection of portal and superior mesenteric veins (SMV) was required in 49%, with resection isolated to PV in 12% and SMV in 39%. Splenic vein ligation was necessary in 30%. Median graft diameter was 12 mm (range 8 to 20 mm), with the majority being ring-enforced (73%). Median operative and vascular clamp times were 463 and 41 minutes, respectively, with median blood loss of 1,500 mL. The negative margin rate was 64%. Overall morbidity rate was 46%, and 30-day mortality was 6%. No patients developed irreversible hepatic necrosis or graft infection. Pancreatic fistulas occurred in 3 (9.1%). With mean follow-up of 14 months, overall graft patency was 76%. Estimated median duration of graft patency was 21 months. Median survival was 12 months for pancreatic adenocarcinoma. CONCLUSIONS With careful patient selection, PTFE graft reconstruction of resected PV/SMV during pancreaticoduodenectomy is possible with minimal risk of hepatic necrosis or graft infection. Comparison studies to primary anastomosis and autologous vein reconstruction are necessary.
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Affiliation(s)
- Carrie K Chu
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
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Nguyen JH. Authors' reply: interposition graft with polytetrafluoroethylene for mesenteric and portal vein reconstruction after pancreaticoduodenectomy ( Br J Surg 2009; 96: 247–252). Br J Surg 2009. [DOI: 10.1002/bjs.6672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- J H Nguyen
- Division of Transplant Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, Florida 32224, USA
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