Major vascular resection and prosthetic replacement for retroperitoneal tumors.
BACKGROUND
Involvement of major vascular structures has been considered a limiting factor for resecting advanced tumors. The objective of this study was to evaluate the outcome after concomitant retroperitoneal tumor and vascular resection with prosthetic replacement of the aorta/vena cava.


METHODS
The authors reviewed a 5-year series of eight patients with a median age of 50 years (range 11-68 years) who had undergone resection of a retroperitoneal tumor and concomitant resection and replacement of the abdominal aorta, inferior vena cava, or both. The histologic diagnoses were sarcoma (five patients), teratoma (one), transitional cell carcinoma (one), and ganglioneuroma (one). The main outcome measures were early (<30 days) and late (>or=30 days) surgical morbidity and mortality. Secondary endpoints were vascular graft patency and tumor-free survival. Two patients underwent combined graft replacement of the aorta and vena cava. Single aortic and vena cava graft replacement were each done in three patients.


RESULTS
Two patients showed early surgical morbidity necessitating reoperation for a thrombotic graft occlusion. No patient died during the early course of the follow-up. During a median follow-up of 14 months (range 1-56 months), two patients had late surgical morbidity. The median tumor-free survival for patients with malignancy was 14 months (range 1-54 months). One patient developed locoregional tumor recurrence, and two developed distant metastases. The median survival for patients with malignancy was 14 months (range 1-60 months).


CONCLUSIONS
An aggressive surgical approach for otherwise unresectable retroperitoneal tumors with vascular resection and prosthetic vascular replacement is justified in selected cases and has acceptable morbidity and mortality.
Fueglistaler
Philipp
P
University Centre for Vascular Surgery, Aarau/Basel, and Department of General Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
Gurke
Lorenz
L
Stierli
Peter
P
Obeid
Tamim
T
Koella
Christoph
C
Oertli
Daniel
D
Kettelhack
Christoph
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D001012:Aorta, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002295:Carcinoma, Transitional Cell / Q000601:surgery; D002648:Child; D005260:Female; D005729:Ganglioneuroma / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012186:Retroperitoneal Neoplasms / Q000601:surgery*; D012509:Sarcoma / Q000601:surgery; D013724:Teratoma / Q000601:surgery; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000601:surgery*