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Vascular Interventions In Gynecologic Oncology Surgery: Outcomes At A Tertiary Medical Center
Milan Ho1, Arash Fereydooni, MD, MS, MHS
2, Babak Litkouhi, MD
2, Amer Karam, MD
2, Jason T. Lee, MD
2, Edmund J. Harris, Jr., MD
2, Elizabeth L. George, MD, MS
2.
1UT Southwestern Medical Center, Dallas, TX, USA,
2Stanford Medicine, Stanford, CA, USA.
OBJECTIVES: Gynecologic oncologic surgeries can involve pelvic and retroperitoneal blood vessels due to anatomical proximity to the reproductive tract. Vascular interventions in these operations are preoperatively planned or unplanned intraoperative consults, with anecdotally variable results.
METHODS: Single-site retrospective cohort study of patients undergoing surgery for gynecologic malignancy from 2001-2023. Abstracted data included demographic, preoperative clinicopathologic, intraoperative, and postoperative variables. We compared morbidity and mortality following vascular interventions.
RESULTS: Vascular interventions during gynecologic oncology surgery were performed in 24 patients (median age 60.5). 67 vessels were mobilized and 32 vessels (21 veins, 11 arteries) intervened upon. 54% of interventions were preoperatively planned. We found no statistically significant difference in blood loss, transfusion requirements, operative time, vascular surgical complexity, postoperative complications or hospital stay (median 6.5 days) for preoperatively planned versus unplanned intraoperative consultations. Preoperatively planned interventions were more likely to receive a preoperative central line and have more vessels mobilized (p<0.05). Patients experienced low rates of Clavien-Dindo grade III+ complications (29%). All patients were postoperatively treated with anti-thrombotics and underwent surveillance imaging, with median time to last follow-up of 33.5 months. 1-year survival rate was 82% and 5-year survival rate was 64%. One of six (17%) patients who underwent arterial reconstruction developed acute limb ischemia on the evening of surgery requiring revision with interposition bypass grafting, but all were patent at last follow up. Tumor venous thrombectomy was performed successfully in three patients. One of eleven (9%) patients who underwent venous repair or reconstruction experienced early graft thrombosis treated with oral anticoagulation and ultimately resolved. All six patients who underwent unilateral iliac or infrarenal caval venous ligation did not experience major vascular complications, in part due to pre-op malignancy-related impaired venous return. Hypogastric artery ligation (one intra-op and two pre-op embolization) was well-tolerated.
CONCLUSIONS: Despite finding no statistically significant differences in patient outcomes, given the infrequency of vascular interventions in gynecologic oncologic surgery, in our practice we find that preoperative planning improves operational efficiency and facilitates shared decision-making. Our data suggest that vascular collaboration with gynecologic oncology in a variety of pathologies and procedures can benefit patients with gynecologic malignancies.
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