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Gomes FJSDDV, Vasconcelos AR, Sahagoff IVG, de Oliveira JCP. Oncovascular surgery. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e2024S103. [PMID: 38865523 PMCID: PMC11164269 DOI: 10.1590/1806-9282.2024s103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 06/14/2024]
Affiliation(s)
- Francisco João Sahagoff de Deus Vieira Gomes
- Universidade do Estado do Rio de Janeiro, Faculty of Medical Sciences, Department of Surgery, Military Police of the State of Rio de Janeiro, Brazilian Society of Angiology and Vascular Surgery – Rio de Janeiro (RJ), Brazil
| | | | | | - Julio Cesar Peclat de Oliveira
- Brazilian Society of Angiology and Vascular Surgery, Technical Chamber of Vascular Surgery of the Regional Council of Medicine of the State of Rio de Janeiro, Vascular Surgery Technical Chamber of the Federal Council of Medicine – São Paulo (SP), Brazil
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2
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Magnus L, Di Marco A, Thaveau F, Georg Y. Oncovascular Surgery for Soft-Tissue Sarcomas of the Lower Limbs with Vascular Contact: Comparison of Arterial Reconstruction and Arterial Subadventitial Dissection. Ann Vasc Surg 2024; 101:204-208. [PMID: 38307229 DOI: 10.1016/j.avsg.2023.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/17/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Soft-tissue sarcomas represent approximately 1% of adult malignancies. When they involve the lower limbs (LLs) and come into contact with blood vessels, the therapeutic choice was historically a primary amputation. Today, radical surgical resection with wide margins of safety is the primary therapeutic option for multidisciplinary limb-salvage surgery. The aim was to compare the morbidity and mortality results of an oncologic resection of LL soft-tissue sarcomas with arterial replacement (AR) to that obtained with arterial subadventitial dissection (ASD). METHODS All consecutive patients with arterial close contact soft-tissue sarcomas of LL were included. Two groups were formed: an AR group where AR was performed following surgical resection and an ASD group in which the artery in contact with the tumor was preserved by ASD. Fisher's exact test was used. RESULTS Eighteen patients with a median age of 61.50 (interquartile range [IQR] 54.25-69.75) years underwent oncovascular surgery with orthopedic and vascular surgeons between August 2013 and May 2022. Sarcomas were all located in the thigh. Nine patients were enrolled in each of the 2 groups. The 6-month survival rate was 77.78% in the AR group and 100% in the ASD group (P = 0.4). In the AR group, 2 patients presented local recurrence, with a median recurrence-free time of 24.48 (IQR 14.08-34.87) months, and 2 patients presented distant metastases, with metastasis-free time of 13.45 (IQR 8.12-35.11) months. In the ASD group, no local recurrence was observed, and 2 patients presented metastases with a median metastasis-free time of 3.90 (IQR 3.18-4.61) months. Six patients in the AR group and 7 in the ASD group required surgical revision (P = 0.017). No major amputation was necessary. CONCLUSIONS Oncovascular surgery for LL sarcomas with ASD is certainly more locally morbid perioperatively than that with AR but provides patients with better medium-term survival.
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Affiliation(s)
- Louis Magnus
- Department of Vascular and Endovascular Surgery, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
| | - Antonio Di Marco
- Department of Orthopedic Surgery and Traumatology, Pôle Santé La Ligne Bleue, Épinal, France
| | - Fabien Thaveau
- Department of Vascular and Endovascular Surgery, Gabriel Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Yannick Georg
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
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3
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Han A, Min SK. Ectopic Variceal Bleeding from the Hepaticojejunostomy due to Extrahepatic Portal Vein Occlusion: How to Treat? Vasc Specialist Int 2023; 39:22. [PMID: 37667820 PMCID: PMC10480048 DOI: 10.5758/vsi.230053] [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: 06/17/2023] [Revised: 07/31/2023] [Accepted: 08/08/2023] [Indexed: 09/06/2023] Open
Abstract
Atypical variceal bleeding, which primarily stems from extrahepatic portal vein obstruction (EHPVO), is a severe complication of pancreatic hepatobiliary surgery. This review provides insights into this condition's incidence, diagnosis, and management strategies. The treatment modalities for atypical variceal bleeding resulting from EHPVO range from endoscopic intervention to surgical procedures, including direct variceal ligation and shunt surgery. Here, we discuss the efficacy and potential limitations of each treatment approach. Additionally, we explored the utility and therapeutic advantages of the meso-Rex shunt, a particularly promising surgical technique for mitigating the hemodynamic and metabolic impacts of EHPVO.
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Affiliation(s)
- Ahram Han
- Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Kee Min
- Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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4
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Sambri A, Fiore M, Rottoli M, Bianchi G, Pignatti M, Bortoli M, Ercolino A, Ancetti S, Perrone AM, De Iaco P, Cipriani R, Brunocilla E, Donati DM, Gargiulo M, Poggioli G, De Paolis M. A Planned Multidisciplinary Surgical Approach to Treat Primary Pelvic Malignancies. Curr Oncol 2023; 30:1106-1115. [PMID: 36661733 PMCID: PMC9857743 DOI: 10.3390/curroncol30010084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
The pelvic anatomy poses great challenges to orthopedic surgeons. Sarcomas are often large in size and typically enclosed in the narrow confines of the pelvis with the close proximity of vital structures. The aim of this study is to report a systematic planned multidisciplinary surgical approach to treat pelvic sarcomas. Seventeen patients affected by bone and soft tissue sarcomas of the pelvis, treated using a planned multidisciplinary surgical approach, combining the expertise of orthopedic oncology and other surgeons (colleagues from urology, vascular surgery, abdominal surgery, gynecology and plastic surgery), were included. Seven patients were treated with hindquarter amputation; 10 patients underwent excision of the tumor. Reconstruction of bone defects was conducted in six patients with a custom-made 3D-printed pelvic prosthesis. Thirteen patients experienced at least one complication. Well-organized multidisciplinary collaborations between each subspecialty are the cornerstone for the management of patients affected by pelvic sarcomas, which should be conducted in specialized centers. A multidisciplinary surgical approach is of paramount importance in order to obtain the best successful surgical results and adequate margins for achieving acceptable outcomes.
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Affiliation(s)
- Andrea Sambri
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Michele Fiore
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Matteo Rottoli
- General Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | | | - Marco Pignatti
- Plastic Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Marta Bortoli
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Amelio Ercolino
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Stefano Ancetti
- Vascular Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Anna Myriam Perrone
- Gynecologic Oncoloy Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Pierandrea De Iaco
- Gynecologic Oncoloy Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Riccardo Cipriani
- Plastic Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Eugenio Brunocilla
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | | | - Mauro Gargiulo
- Vascular Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Gilberto Poggioli
- General Surgery Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Massimiliano De Paolis
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Kang J, Choi KW, Han A, Min S, Heo SH, Yang SS, Park YJ, Min SK. Venous Reconstruction in Extremity Soft Tissue Sarcoma Is Not Essential. Vasc Endovascular Surg 2023; 57:365-372. [PMID: 36592476 DOI: 10.1177/15385744221150737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Limb salvage is an important concern following complete oncologic resection for extremity soft tissue sarcoma (STS). Vascular reconstruction is essential for limb salvage. The purpose of this study was to evaluate the outcomes of vascular reconstruction in patients with extremity STS. METHODS This is a retrospective, multi-center, case series of consecutive patients who underwent vascular reconstruction during extremity STS resection at 2 major centers in Korea. Demographics, reconstruction methods, type of conduit, surgical complications, graft patency, limb salvage rate, and patient survival were reviewed. RESULTS From March 2005 to December 2020, 43 patients underwent vascular reconstructions during STS resection. Among the patients, 22 (51.2%) received arterial only, and 21 (48.8%) received simultaneous arterial and venous reconstructions. For the types of conduits, autologous saphenous veins (56.2%), artificial grafts (26.3%), and cryopreserved allografts (15.8%) were used. During a median follow-up of 23.8 months (interquartile range; 7.7-54.5), the overall primary patency of the reconstructed vessels was significantly higher in arteries than in veins (82.5% vs 56.3% at 12 months, P < .001). According to the type of conduit, the primary patency rate of autogenous vein seemed higher in venous reconstruction, however, there was no statistical significance in both arterial and venous reconstruction. There was no significant difference in primary arterial patency rate (P = .132) or incidence of surgical complications including postoperative edema or wound problem whether or not simultaneous venous reconstruction was performed with arterial reconstruction. The overall limb salvage rate and patient survival were 97.4%, 95.1%, and 89.4% and 91.9%, 81.7%, and 65.4% at 12, 24, and 36 months, respectively. CONCLUSIONS Patency rates were poorer in venous reconstruction than in arterial reconstruction. In terms of arterial patency and postoperative complication, the role of simultaneous arterial and venous reconstruction seems not essential, however, it needs to be evaluated in future studies.
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Affiliation(s)
- Jihee Kang
- Division of Vascular Surgery, Department of Surgery, Inha University Hospital, Inha University School of Medicine, Jung-gu, Incheon, Korea
| | - Kwang Woo Choi
- Division of Vascular Surgery, Department of Surgery, 37990Seoul National University College of Medicine, Jongno-gu, Seoul, Korea
| | - Ahram Han
- Division of Vascular Surgery, Department of Surgery, 37990Seoul National University College of Medicine, Jongno-gu, Seoul, Korea
| | - Sangil Min
- Division of Vascular Surgery, Department of Surgery, 37990Seoul National University College of Medicine, Jongno-gu, Seoul, Korea
| | - Seon-Hee Heo
- Department of Surgery, Yonsei Severance Hospital, 37991Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea
| | - Shin-Seok Yang
- Division of Vascular Surgery, Department of Surgery, Heart Vascular Stroke Institute, 36626Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Heart Vascular Stroke Institute, 36626Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Korea
| | - Seung-Kee Min
- Division of Vascular Surgery, Department of Surgery, 37990Seoul National University College of Medicine, Jongno-gu, Seoul, Korea
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Seretis C, Tsimpoukis A, Georgiakakis A, Kitrou P, Panteli E, Papadoulas SI. Patient Transfer with Kocher Forceps on the Axillary Artery: A Rare Case of Ongoing Iatrogenic Vascular Injury. Vasc Specialist Int 2022; 38:10. [PMID: 35383133 PMCID: PMC8984864 DOI: 10.5758/vsi.220010] [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: 02/07/2022] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 11/20/2022] Open
Abstract
Iatrogenic trauma of the axillary artery by non-vascular surgeons can occur during various general surgical procedures such as resection of soft tissue tumors or axillary lymph node clearance. Prompt recognition, appropriate initial management, and rapid transfer to a tertiary vascular surgery service, if needed, are key steps to ensuring patient safety. Here we present a case of iatrogenic axillary artery injury during the resection of a recurrent soft tissue tumor in a local hospital. The desperate application of a Kocher clamp on the bleeding axillary artery by the operating general surgeons controlled the bleeding but led to further arterial damage. The patient was transferred to our tertiary hospital, where the arterial injury was repaired using a vein interposition graft. Apart from the encountered intraoperative technical challenges, this case highlights the need for broader training of non-vascular specialist surgeons on the core principles of basic vascular surgical techniques and oncovascular surgery.
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Affiliation(s)
- Charalampos Seretis
- Department of Vascular Surgery, University Hospital of Patras, Patras, Greece
| | - Andreas Tsimpoukis
- Department of Vascular Surgery, University Hospital of Patras, Patras, Greece
| | | | - Panagiotis Kitrou
- Department of Interventional Radiology, University Hospital of Patras, Patras, Greece
| | - Eleftheria Panteli
- Department of Anesthesiology, University Hospital of Patras, Patras, Greece
| | - Spyros I Papadoulas
- Department of Vascular Surgery, University Hospital of Patras, Patras, Greece
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7
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Li WX, Tong HX, Lv CT, Yang H, Zhao G, Lu WQ, Zhang Y. Management of retroperitoneal sarcoma involving the iliac artery: Single-center surgical experience. World J Clin Cases 2022; 10:811-819. [PMID: 35127897 PMCID: PMC8790436 DOI: 10.12998/wjcc.v10.i3.811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/15/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Management of retroperitoneal sarcoma (RPS) involving the iliac artery is challenging and requires the concerted efforts of multidisciplinary team (MDT) members during surgical treatment.
AIM To summarize the clinicopathologic features of RPS involving the iliac artery and our retroperitoneal soft tissue tumor MDT surgical experience.
METHODS In this retrospective study, 15 patients with RPS involving the iliac artery who underwent surgery at our retroperitoneal soft tissue tumor center from July 2004 to June 2020 were analyzed. Statistical analyses were performed by Student’s t-test with SPSS 16.0.
RESULTS Complete tumor resection (R0/R1) and iliac artery reconstruction were achieved in all 15 patients. All the operations were successful, with no serious complications or perioperative death. Resection with bilateral iliac artery reconstruction required a higher intraoperative blood transfusion volume than resection with unilateral iliac artery reconstruction. Recurrent cases were more likely to bleed and required a higher blood transfusion volume than primary cases. As of January 2021, 11 patients were alive, and 4 had died. Local recurrence occurred in two patients, one of whom developed liver metastasis.
CONCLUSION Resection of RPS involving iliac vessels is feasible and effective when performed by MDT members. Iliac artery oncovascular resection and reconstruction are key to a successful operation. Adequate blood preparation is important for successful completion of surgery.
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Affiliation(s)
- Wen-Xiang Li
- Department of General Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai 200083, China
| | - Han-Xing Tong
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Chen-Tao Lv
- Department of General Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai 200083, China
| | - Hua Yang
- Department of General Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai 200083, China
| | - Gang Zhao
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Wei-Qi Lu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yong Zhang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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8
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Jurado M, Chiva L, Tinelli G, Alcazar JL, Chi DS. The role of oncovascular surgery in gynecologic oncology surgery. Int J Gynecol Cancer 2022; 32:553-559. [PMID: 35022310 DOI: 10.1136/ijgc-2021-003129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Oncovascular surgery is a new term used to define tumor resection with simultaneous reconstruction of the great vessels when the tumor infiltrates or firmly adheres to such vessels. The benefit of oncovascular surgery has been widely described in patients with hepato-biliary-pancreatic cancers, retroperitoneal soft tissue sarcoma, and in other areas of gynecologic oncology, such as the lateral compartment of the pelvis, retroperitoneum, and hepato-biliary-pancreatic region, with an increase in complete resections and without increasing the morbidity and mortality rates. In the latter decades of the past century, several advances and accumulating scientific evidence led gynecologic oncologists to perform more thorough cytoreductive surgeries that included multivisceral resections. But to our knowledge, published studies on the frequency and relevance of vascular surgery in gynecological oncology are scarce. Gynecologic oncologists still do not receive formal training in vascular surgery and additionally, with the current reduction in experience with pelvic and para-aortic lymphadenectomy, as well as other types of radical abdominal and pelvic surgeries, trainees will encounter fewer vascular injuries and the opportunity to deal with a variety of management types required. Well-organized collaboration between each subspecialty with a multidisciplinary approach and adequate pre-operative planning are pivotal. The aim of this review is to pave the way towards the understanding that patients with suspicion of great vessels' infiltration or encasement by tumor require personalized and specialized treatment with the need to form an oncovascular surgery team, and that it is necessary for gynecologic oncology surgeons to take a step forward in surgical training.
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Affiliation(s)
- Matias Jurado
- Department of Obstetrics and Gynecology, Universidad de Navarra, Pamplona, Spain
| | - Luis Chiva
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Madrid, Madrid, Spain
| | - Giovanni Tinelli
- Endovascular Therapies, Vascular Surgery Unit Cardiovascular Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Lazio, Italy
| | - Juan Luis Alcazar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Navarra, Spain
| | - Dennis S Chi
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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9
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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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10
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Oncovascular Surgery: The Current Situation and Future Perspectives in Europe. Eur J Vasc Endovasc Surg 2021; 63:350-351. [PMID: 34972625 DOI: 10.1016/j.ejvs.2021.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/25/2021] [Accepted: 11/08/2021] [Indexed: 12/19/2022]
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11
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Cruz SM, Basmaci UN, Bateni CP, Darrow MA, Judge SJ, Monjazeb AM, Thorpe SW, Humphries MD, Canter RJ. Surgical and oncologic outcomes following arterial resection and reconstruction for advanced solid tumors. J Surg Oncol 2021; 124:1251-1260. [PMID: 34495553 DOI: 10.1002/jso.26665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/16/2021] [Accepted: 08/28/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND OBJECTIVES Although arterial involvement for advanced tumors is rare, vascular resection may be indicated to achieve complete tumor resection. Given the potential morbidity of this approach, we sought to evaluate perioperative outcomes, vascular graft patency, and survival among patients undergoing tumor excision with en bloc arterial resection and reconstruction. METHODS From 2010 to 2020, we identified nine patients with tumors encasing or extensively abutting major arterial structures for whom en bloc arterial resection and reconstruction was performed. RESULTS Mean age was 53 ± 20 years, and 89% were females. Diagnoses were primary sarcomas (5), recurrent gynecologic carcinomas (3), and benign retroperitoneal fibrosis (1). Tumors involved the infrarenal aorta (2), iliac arteries (6), and superficial femoral artery (1). Three patients (33%) had severe perioperative morbidity (Grade III + ) with no mortality. At a median follow-up of 23 months, eight patients (89%) had primary graft patency, and five patients (56%) had no evidence of disease. CONCLUSIONS Arterial resection and reconstruction as part of the multimodality treatment of regionally advanced tumors is associated with acceptable short- and long-term outcomes, including excellent graft patency. In appropriately selected patients, involvement of major arterial structures should not be viewed as a contraindication to attempted curative surgery.
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Affiliation(s)
- Sylvia M Cruz
- Department of Surgery, UC Davis School of Medicine, Sacramento, California, USA
| | - Ugur N Basmaci
- Department of Surgery, UC Davis School of Medicine, Sacramento, California, USA
| | - Cyrus P Bateni
- Division of Musculoskeletal Radiology, UC Davis Comprehensive Cancer Center, Sacramento, California, USA
| | - Morgan A Darrow
- Department of Pathology and Laboratory Medicine, UC Davis Medical Center, Sacramento, California, USA
| | - Sean J Judge
- Division of Surgical Oncology, UC Davis Comprehensive Cancer Center, Sacramento, California, USA
| | - Arta M Monjazeb
- Department of Radiation Oncology, UC Davis Medical Center, Sacramento, California, USA
| | - Steven W Thorpe
- Department of Orthopedic Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Misty D Humphries
- Division of Vascular and Endovascular Surgery, UC Davis Medical Center, Sacramento, California, USA
| | - Robert J Canter
- Division of Surgical Oncology, UC Davis Comprehensive Cancer Center, Sacramento, California, USA
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12
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Jurado M, Chiva L. Oncovascular surgery: is it time for a step forward in gynecologic oncology surgery? Int J Gynecol Cancer 2021; 31:1315. [PMID: 34301757 DOI: 10.1136/ijgc-2021-002912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/09/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Matias Jurado
- Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Luis Chiva
- Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona, Spain
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13
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Kalmykov EL, Gaibov AD, Nematzoda O, Sharipov MA, Baratov AK. [Some aspects of iatrogenic vessel injury]. Khirurgiia (Mosk) 2021:85-91. [PMID: 33759475 DOI: 10.17116/hirurgia202104185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Iatrogenic events made up 1-10% of in-hospital mortality. Currently, iatrogenic vascular injuries are described for almost all surgical areas. Incidence of iatrogenic vascular injuries is gradually increased that is primarily associated with high number of percutaneous endovascular interventions. Surgical treatment of patients with iatrogenic vessel injuries is extremely difficult. This is due to sudden development of this complication, severe clinical state of the patient associated with underlying disease, acute massive blood loss, as well as insufficient experience of surgeon in urgent vascular surgery. Simple lateral or circular suturing is not always possible to restore the vessel integrity. Vascular replacement including non-standard vascular reconstructions are often required. Prevention of iatrogenic vascular injuries is also insufficiently described in the literature. Most manuscripts devoted to iatrogenic vascular injuries are usually represented by case reports or small sample. Thus, it is impossible to identify the main measures for prevention of iatrogenic injury.
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Affiliation(s)
| | - A D Gaibov
- Avicenna Tajik State Medical University, Dushanbe, Tajikistan
| | - O Nematzoda
- Republican Research Center for Cardiovascular Surgery, Dushanbe, Tajikistan
| | - M A Sharipov
- Avicenna Tajik State Medical University, Dushanbe, Tajikistan
| | - A K Baratov
- Republican Research Center for Cardiovascular Surgery, Dushanbe, Tajikistan
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14
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Kontopodis N, Bree ED, Michelakis D, Ioannou CV. Oncovascular Resection and Reconstruction of Recurrent Retroperitoneal Liposarcoma Adherent to the Iliac Veins and Vena Cava. Vasc Specialist Int 2021; 37:58-59. [PMID: 33753575 PMCID: PMC8021491 DOI: 10.5758/vsi.210017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, Heraklion, Greece
| | - Eelco de Bree
- Department of Surgical Oncology, University of Crete Medical School, Heraklion, Greece
| | | | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, Heraklion, Greece
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Kontopodis N, Igoumenakis D, Mastorakis G, Logothetis I, Daskalakis N, Ioannou CV. Local Metastatic Neck Cancer Involving the Distal Internal Carotid Artery Treated with En Bloc Resection and Arterial Reconstruction after Mandibular Osteotomy. Vasc Specialist Int 2020; 36:252-257. [PMID: 33177248 PMCID: PMC7790687 DOI: 10.5758/vsi.200046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/02/2020] [Accepted: 10/09/2020] [Indexed: 11/20/2022] Open
Abstract
Head and neck cancers represent an aggressive form of neoplastic diseases that warrant surgical resection, in order to achieve optimal outcomes. Moreover, the involvement of the carotid artery is associated with a dismal prognosis and radical tumor resection becomes challenging. The current case report presents a patient with locally metastatic neck carcinoma attached to the right carotid bifurcation, involving both the external and internal carotid arteries up to the distal segment of the internal carotid artery (ICA) at the level of the C1 vertebra. The patient underwent en bloc tumor and vessel resection. The carotid artery was reconstructed using an interposition graft from the common carotid artery to the ICA by means of an autologous saphenous vein graft. A vertical mandibular osteotomy was performed, in order to expose the distal ICA. The postoperative recovery was uneventful. The patient was under follow-up for six months, without any signs of recurrence.
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Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Vascular and Cardiothoracic Surgery, University of Crete Medical School, Heraklion, Greece
| | - Dimosthenis Igoumenakis
- Department of Oral and Maxillofacial Surgery, Venizeleio General Hospital, Heraklion, Greece
| | - George Mastorakis
- Department of Oral and Maxillofacial Surgery, Venizeleio General Hospital, Heraklion, Greece
| | - Ioannis Logothetis
- Department of Oral and Maxillofacial Surgery, Venizeleio General Hospital, Heraklion, Greece
| | - Nikolaos Daskalakis
- Vascular Surgery Unit, Department of Vascular and Cardiothoracic Surgery, University of Crete Medical School, Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Vascular and Cardiothoracic Surgery, University of Crete Medical School, Heraklion, Greece
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Crucial Roles of Vascular Surgeons in Oncovascular and Non-Vascular Surgery. Eur J Vasc Endovasc Surg 2020; 60:764-771. [DOI: 10.1016/j.ejvs.2020.08.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/14/2020] [Accepted: 08/18/2020] [Indexed: 12/26/2022]
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Perhavec A, Provenzano S, Baia M, Sangalli C, Morosi C, Barisella M, Colombo C, Radaelli S, Pasquali S, Callegaro D, Gronchi A, Fiore M. Inoperable Primary Retroperitoneal Sarcomas: Clinical Characteristics and Reasons Against Resection at a Single Referral Institution. Ann Surg Oncol 2020; 28:1151-1157. [PMID: 32632883 DOI: 10.1245/s10434-020-08789-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/12/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The outcome of patients with retroperitoneal sarcomas (RPS) depends mainly on tumor biology and completeness of surgical resection. However, some patients are deemed not resectable for various reasons. This study analyzed a series of primary RPS patients to describe rate and reasons of primary inoperability at a large referral center. METHODS All consecutive patients affected by primary localized RPS referred for surgical treatment at our institution between January 1, 2013 and December 31, 2017 were analyzed. Patients were split in two groups: those who underwent surgical resection with curative intent, and those who were not resected. RESULTS A total of 322 patients were available for the current analysis: 285 (88.5%) underwent resection with curative intent, and 37 (11.5%) did not. Twenty of 322 (6.2%) patients who did not undergo resection had a technically unresectable tumor, whereas the remaining 18 of 322 (5.6%) were not amenable to a major surgical procedure due to comorbidities/poor performance status. The dominant technical reason was involvement of the celiaco-mesenteric vessels. At a median follow-up from the diagnosis of 34 months, 24 of 37 (64.9%) nonoperated and 48 of 285 (16.8%) operated patients died. The corresponding 4-year overall survival were 10.3% and 83.4%, respectively (p < 0.001). CONCLUSIONS Roughly, 10% of patients who presented with localized primary RPS at a large referral institution were not resected. An attempt to standardize the definition of resectability for primary localized RPS should be made considering anatomic, biologic, and patient-related factors.
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Affiliation(s)
- Andraz Perhavec
- Department of Surgery, Institute of Oncology Ljubljana, Ljubljana, Slovenia.,European School of Soft Tissue Sarcoma Surgery, Milan, Italy
| | - Salvatore Provenzano
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Baia
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudia Sangalli
- Department of Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Morosi
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marta Barisella
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Chiara Colombo
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stefano Radaelli
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sandro Pasquali
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Dario Callegaro
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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Finlay B, Bednarz J, Dawson J. A Multidisciplinary Approach to Oncological Resections with Vascular Surgeons Improves Patient Outcomes. Eur J Vasc Endovasc Surg 2020; 60:293-299. [PMID: 32402805 DOI: 10.1016/j.ejvs.2020.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/12/2020] [Accepted: 04/08/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Oncological resections have become more radical in pursuit of disease free margins. Consequently, vascular structures may be injured inadvertently or purposely resected, with or without subsequent reconstruction. Thus, vascular surgeons have an increasing role in oncological surgery. The present authors sought to review their experience and examine the effect of timing of referral to a Vascular Surgeon (VS) on patient and surgical outcomes following tumour resection. METHODS A retrospective review was conducted of a prospectively maintained database at a public hospital network in Adelaide, Australia. All cases of collaboration between a VS and other surgeons for resection of cancer or non-malignant tumour were included. Medical records and operative, pathological, and transfusion data were reviewed, with particular attention to referring team, timing of VS referral (pre- or intra-operative), and the operative role of the VS. RESULTS Seventy-two cases were identified from January 2004 to June 2018. The most common collaborators were General Surgery and Urology. Of the cases, 86% were elective and 71% were referred to the VS pre-operatively. Pre-operative referral was associated with a predominant VS role of dissection and exposure. Pre-operative referral was associated with lower odds of vessel repair and reconstruction compared with intra-operative referral (adjusted OR = 0.20; 95% CI 0.04-0.93; p = .040) and a lower incidence of positive surgical margins (35% vs. 80%, p = .028). The rate of blood product units required was lower among pre-operative referrals relative to intra-operative referrals, but the effect of timing was not significant after adjustment for potential confounders (IRR = 0.80, 95% CI 0.26-2.44; p = .70). CONCLUSION Pre-operative planned involvement of vascular surgery in oncological operations can improve surgical outcomes, with additional expected benefits for surgical training and cross specialty collaboration.
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Affiliation(s)
- Ben Finlay
- Trauma & Surgical Oncology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
| | - Jana Bednarz
- Adelaide Health Technology Assessment, University of Adelaide, Adelaide, South Australia, Australia
| | - Joe Dawson
- Trauma & Surgical Oncology Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Department of Vascular & Endovascular Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia
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Sallam K, Khairy H. Oncovascular Surgery and the Making of the Oncovascular Surgeon. Vasc Specialist Int 2019; 35:189-192. [PMID: 31915662 PMCID: PMC6941767 DOI: 10.5758/vsi.2019.35.4.189] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/26/2019] [Accepted: 12/04/2019] [Indexed: 11/20/2022] Open
Abstract
Patients diagnosed with tumors that are located in vicinity of the major axial vessels are inconsistently managed because they are often considered unresectable. The management of these patients remains at the periphery of various established sub-specialties that are prevalent under the current medical specialty. These patients are required to be treated by an oncovascular surgeon. This article discusses some key points in understanding the reasons for establishing a specialty branch, oncovascular surgery, to treat complex tumors with vessel invasion. This article also reviews important issues about leadership and how to train and educate oncovascular surgeons.
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Affiliation(s)
- Kareem Sallam
- Consultant and Lecturer of Oncovascular Surgery, Helwan University and National Cancer Institute, Egypt
| | - Hussein Khairy
- Professor of General and Vascular Surgery, Cairo University, Cairo, Egypt
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20
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Han SM. Oncovascular Surgery: There Would Be No Such Thing without Vascular Surgeons. Vasc Specialist Int 2019; 35:53-54. [PMID: 31297353 PMCID: PMC6609018 DOI: 10.5758/vsi.2019.35.2.53] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sukgu M Han
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Comprehensive Aortic Center, Keck Hospital of USC, University of Southern California, Los Angeles, CA, USA
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