Oncovascular Surgery - Operating Major Retroperitoneal Tumors with Vascular Involvement may be Justified
Ilkka K. Kantonen, Pirkka Vikatmaa, Ilkka Perttila, Ari Leppaniemi, Ilkka Heiskanen, Jukka Siren, Heikki Makisalo, Anders Alback.
Helsinki University Hospital, Helsinki, Finland.
Ilkka Kantonen, Pirkka Vikatmaa, Ilkka Perttilä, Ari Leppaniemi, Ilkka Heiskanen, Jukka Siren, Heikki Makisalo, Anders Albäck
ObjectiveDevelopments in oncological care and maybe surgical techniques have led to an increase in the resections of retroperitoneal tumours previously deemed inoperable. These tumours are often in contact or infiltrating major vessels and thus vascular surgeons should be consulted. The tumours however represent various pathologies and vascular surgeons are mostly unaware of their nature and behaviour as well as options for adjuvant therapies. Therefore a multidisciplinary approach in the treatment and diagnostics of these patients is mandatory. We have moved from a previously person based consultation pattern to a multidisciplinary oncovascular meeting and try to accumulate our knowledge on these rare pathologies with a systematic consultation pattern.
We present a patient series of retroperitoneal tumours operated during 2014-2015 where at least one vascular surgeon was involved in the operation. Pancreatic tumours with portal reconstructions were excluded. Electronic patient data files were used for data collection.
Results52 patients were operated during the two years, 20 for renal carcinoma involving the vena cava, 13 for testicular carcinoma metastases involving the lymphatic tissue around the aorta and vena cava and 19 for a variety of large tumours including 8 sarcomas. 78.8% (41/52) of the operations were considered radical at the end of the procedure. Vascular reconstruction using allografts, prosthesis or bovine pericardium was performed in twenty (38.5%) operations. In order to prevent prolonged renal ischemia, temporary axillorenal bypass was used in 3 (5.2%) cases. Two (3.8%)
patients died within the first 90 days: one had presented in cardiogenic shock due to a massive pheocromocytoma and one clear cell renal carcinoma patient died due to intracranial bleeding from a previously nondiagnosed cerebral metastasis. Twelve (23.1%) patients died during the follow-up and 29 (55.8%) were known to be disease free. Death rates were 5/20 (25.0%) for renal tumours, 2/13 (15.4%) for testicular tumours and 5/19 (26.3%) for other pathologies. Kaplan-Meier survival for the whole group and in the three groups are presented in the Figure.
Operating major retroperitoneal tumours even with vascular involvement in a multidisciplinary manner with a vascular surgeon involved seems worthwhile.
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