Cargando…

Abdominoinguinal approach in en bloc resection of retroperitoneal sarcoma involving iliac vessels with graft interposition

BACKGROUND: Retroperitoneal sarcomas (RPSs) located in the lower abdominal quadrants involving iliac vessels are difficult to manage. This study introduced a 5-step method for en bloc resection with graft interposition using the abdominoinguinal approach and evaluated its efficacy and safety. METHOD...

Descripción completa

Detalles Bibliográficos
Autores principales: Lv, Ang, Liu, Bo-Nan, Liu, Dao-Ning, Wang, Zhen, Hao, Chun-Yi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9816569/
https://www.ncbi.nlm.nih.gov/pubmed/36620578
http://dx.doi.org/10.3389/fonc.2022.1040833
_version_ 1784864564846788608
author Lv, Ang
Liu, Bo-Nan
Liu, Dao-Ning
Wang, Zhen
Hao, Chun-Yi
author_facet Lv, Ang
Liu, Bo-Nan
Liu, Dao-Ning
Wang, Zhen
Hao, Chun-Yi
author_sort Lv, Ang
collection PubMed
description BACKGROUND: Retroperitoneal sarcomas (RPSs) located in the lower abdominal quadrants involving iliac vessels are difficult to manage. This study introduced a 5-step method for en bloc resection with graft interposition using the abdominoinguinal approach and evaluated its efficacy and safety. METHODS: Data of 24 consecutive patients who met the inclusion criteria from 272 patients with RPS who underwent surgical treatment between April 2015 and April 2022 were retrospectively collected and analyzed. RESULTS: The patients underwent left- or right-sided abdominoinguinal incision. In all patients, the abdominoinguinal approach provided good exposure, and complete resection was achieved. Iliac artery+vein, vein, and artery resection and replacement by graft were performed in 70.8%, 25.0%, and 4.2% of patients, respectively. Additional resected organs mainly included the colon, ureter, bladder, kidney, and abdominal wall. The median number of organs resected was 5. In 37.5% of patients, reconstruction of the lower abdominal wall and inguinal ligament was performed using a mesh. Venous graft thrombosis occurred in 21.7% of patients, while no patient had pulmonary embolism or arterial occlusion. Major complications occurred in 20.8% of patients, and no 30-day mortality was observed. The estimated 5-year local recurrence and distant metastasis rates were 54.4% and 22.1%, respectively, with a median recurrence-free survival of 27 months. CONCLUSIONS: En bloc resection of RPS involving iliac vessels with graft interposition using the abdominoinguinal approach is feasible and advantageous. Good complete resection rate and safety can be achieved. The long-term survival benefit of this surgical approach should be verified by further large-scale prospective controlled studies.
format Online
Article
Text
id pubmed-9816569
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-98165692023-01-07 Abdominoinguinal approach in en bloc resection of retroperitoneal sarcoma involving iliac vessels with graft interposition Lv, Ang Liu, Bo-Nan Liu, Dao-Ning Wang, Zhen Hao, Chun-Yi Front Oncol Oncology BACKGROUND: Retroperitoneal sarcomas (RPSs) located in the lower abdominal quadrants involving iliac vessels are difficult to manage. This study introduced a 5-step method for en bloc resection with graft interposition using the abdominoinguinal approach and evaluated its efficacy and safety. METHODS: Data of 24 consecutive patients who met the inclusion criteria from 272 patients with RPS who underwent surgical treatment between April 2015 and April 2022 were retrospectively collected and analyzed. RESULTS: The patients underwent left- or right-sided abdominoinguinal incision. In all patients, the abdominoinguinal approach provided good exposure, and complete resection was achieved. Iliac artery+vein, vein, and artery resection and replacement by graft were performed in 70.8%, 25.0%, and 4.2% of patients, respectively. Additional resected organs mainly included the colon, ureter, bladder, kidney, and abdominal wall. The median number of organs resected was 5. In 37.5% of patients, reconstruction of the lower abdominal wall and inguinal ligament was performed using a mesh. Venous graft thrombosis occurred in 21.7% of patients, while no patient had pulmonary embolism or arterial occlusion. Major complications occurred in 20.8% of patients, and no 30-day mortality was observed. The estimated 5-year local recurrence and distant metastasis rates were 54.4% and 22.1%, respectively, with a median recurrence-free survival of 27 months. CONCLUSIONS: En bloc resection of RPS involving iliac vessels with graft interposition using the abdominoinguinal approach is feasible and advantageous. Good complete resection rate and safety can be achieved. The long-term survival benefit of this surgical approach should be verified by further large-scale prospective controlled studies. Frontiers Media S.A. 2022-12-23 /pmc/articles/PMC9816569/ /pubmed/36620578 http://dx.doi.org/10.3389/fonc.2022.1040833 Text en Copyright © 2022 Lv, Liu, Liu, Wang and Hao https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Lv, Ang
Liu, Bo-Nan
Liu, Dao-Ning
Wang, Zhen
Hao, Chun-Yi
Abdominoinguinal approach in en bloc resection of retroperitoneal sarcoma involving iliac vessels with graft interposition
title Abdominoinguinal approach in en bloc resection of retroperitoneal sarcoma involving iliac vessels with graft interposition
title_full Abdominoinguinal approach in en bloc resection of retroperitoneal sarcoma involving iliac vessels with graft interposition
title_fullStr Abdominoinguinal approach in en bloc resection of retroperitoneal sarcoma involving iliac vessels with graft interposition
title_full_unstemmed Abdominoinguinal approach in en bloc resection of retroperitoneal sarcoma involving iliac vessels with graft interposition
title_short Abdominoinguinal approach in en bloc resection of retroperitoneal sarcoma involving iliac vessels with graft interposition
title_sort abdominoinguinal approach in en bloc resection of retroperitoneal sarcoma involving iliac vessels with graft interposition
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9816569/
https://www.ncbi.nlm.nih.gov/pubmed/36620578
http://dx.doi.org/10.3389/fonc.2022.1040833
work_keys_str_mv AT lvang abdominoinguinalapproachinenblocresectionofretroperitonealsarcomainvolvingiliacvesselswithgraftinterposition
AT liubonan abdominoinguinalapproachinenblocresectionofretroperitonealsarcomainvolvingiliacvesselswithgraftinterposition
AT liudaoning abdominoinguinalapproachinenblocresectionofretroperitonealsarcomainvolvingiliacvesselswithgraftinterposition
AT wangzhen abdominoinguinalapproachinenblocresectionofretroperitonealsarcomainvolvingiliacvesselswithgraftinterposition
AT haochunyi abdominoinguinalapproachinenblocresectionofretroperitonealsarcomainvolvingiliacvesselswithgraftinterposition