title: Vascular resection en-bloc with tumor removal and graft reconstruction is safe and effective in soft tissue sarcoma (STS) of the extremities and retroperitoneum.
abstract: BACKGROUND
  To analyze the outcome of a series of patients who underwent vascular resection as part of an excision of a soft tissue sarcoma (STS).
  
  
  METHODS
  All consecutive patients affected by localized STS of an extremity or retroperitoneum treated between January 2000 and December 2013 with surgery including vascular resection were considered. Overall survival (OS), crude cumulative incidence (CCI) of local recurrence (LR) and distant metastases (DM) were estimated by Kaplan-Meier. Long-term vascular graft patency rate was assessed.
  
  
  RESULTS
  2692 patients received an operation for localized disease with 105 (3.9%) cases undergoing vascular resection. Median FU was 32 months. 5-year OS, CCI of LR and DM were 62%, 12% and 58% respectively. Vascular reconstructions consisted of 52 arterial and 16 venous grafts in extremities; 12 arterial and 33 venous grafts in the retroperitoneum. Graft thrombosis occurred in 16 patients (7/64 arterial and 9/49 venous reconstructions). Arterial occlusions occurred at a median of 36 months after surgery and were treated by prosthesis replacement (3), Fogarty catheter embolectomy (2), percutaneous angioplasty (1) and observation (1). One patient eventually required amputation. Venous occlusions occurred at a median of 4 months post surgery and were all treated conservatively. Overall arterial and venous reconstruction patency rates were 89% and 82% respectively.
  
  
  CONCLUSIONS
  Vascular resection to facilitate resection of STS has an acceptable long term patency rate. However it was associated to a high risk of distant spread. Although the encasement of the vascular bundle does not represent a contraindication to surgery there is an association with a high metastatic risk by virtue of the locally advanced nature of the disease and this should be considered when planning treatment.
authors: Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: stefano.radaelli@istitutotumori.mi.it.
authors: Stefano
authors: S
authors: Radaelli
authors: Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: marco.fiore@istitutotumori.mi.it.
authors: Marco
authors: M
authors: Fiore
authors: Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: chiara.colombo@istitutotumori.mi.it.
authors: Chiara
authors: C
authors: Colombo
authors: Department of Surgery, University Hospital, Birmingham, United Kingdom. Electronic address: samuel.ford@uhb.nhs.uk.
authors: Samuel
authors: S
authors: Ford
authors: Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: elena.palassini@istitutotumori.mi.it.
authors: Elena
authors: E
authors: Palassini
authors: Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: roberta.sanfilippo@istitutotumori.mi.it.
authors: Roberta
authors: R
authors: Sanfilippo
authors: Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: silvia.stacchiotti@istitutotumori.mi.it.
authors: Silvia
authors: S
authors: Stacchiotti
authors: Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: claudia.sangalli@istitutotumori.mi.it.
authors: Claudia
authors: C
authors: Sangalli
authors: Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: carlo.morosi@istitutotumori.mi.it.
authors: Carlo
authors: C
authors: Morosi
authors: Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: paolo.casali@istitutotumori.mi.it.
authors: Paolo G
authors: PG
authors: Casali
authors: Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: alessandro.gronchi@istitutotumori.mi.it.
authors: Alessandro
authors: A
authors: Gronchi
mesh_terms: D000328:Adult; D005121:Extremities / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D023821:Limb Salvage; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D012186:Retroperitoneal Neoplasms / Q000556:secondary / Q000601:surgery*; D012509:Sarcoma / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000379:methods*
keywords: Extremity sarcoma; Prognostic factors; Retroperitoneal sarcoma; Sarcoma; Surgical oncology; Survival; Vascular sarcoma; Vascular surgery