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Tae K. Song, MD; E. John Harris Jr, MD; Shyam Raghavan, BS; Jeffrey A. Norton, MD

Arch Surg. 2009;144(9):817-822.

Objective  To evaluate the outcomes of major vessel reconstruction as part of surgery to remove sarcomas.

Design  Retrospective review.

Setting  Tertiary academic medical center.

Patients  Fourteen patients (10 female) with retroperitoneal or extremity sarcomas and major blood vessel involvement who underwent surgery to remove the tumor and had blood vessel reconstruction between 2003 and 2008. Each patient underwent computed tomography angiography.

Main Outcome Measures  Early (<30 days) and late (>30 days) operative morbidity and mortality, freedom from disease, and graft patency.

Results  Seven patients had retroperitoneal sarcomas and 7, extremity sarcomas. Thirteen tumors were malignant (7 high grade and 6 low grade) and 1, benign (leiomyoma). Seven patients had replacement of artery and vein; 5, artery only; and 2, vein only. In all, 16 arteries were reconstructed (2 common femoral; 5 iliac; 2 superficial femoral; 1 brachial; 1 popliteal; and 2 aorta, one with implantation of both iliac arteries and the other with implantation of the left renal, superior mesenteric, and hepatic arteries). Eight patients (57%) had 9 veins reconstructed (3 external iliac, 3 superficial femoral, 2 vena cava, and 1 popliteal). Primary arterial patency was 58% and primary-assisted patency was 83%. Venous patency was 78%. Local recurrence occurred in 3 patients (21%). Five-year disease-free and overall survival were 52% and 68%, respectively. Limb salvage was achieved in 93%.

Conclusion  Involvement of vascular structures is not a contraindication for resection of sarcomas, but appropriate planning is necessary to optimize outcome.

Author Affiliations: Divisions of Vascular Surgery (Drs Song and Harris) and General Surgery (Dr Norton), Department of Surgery, and School of Medicine (Mr Raghavan), Stanford University, Stanford, California.

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