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The journal «ONCOSURGERY» 2012, Vol.4, No 3

The significance of vessel reconstruction in cancer patients with severe co-morbidity

Granov АМ, Granov DА, Polysalov VN, Schkolnik МI, Tarazov PG, Maystrenko DN, Pavlovsky АV

Russian Research Center of Radiology and Surgical Techniques, Saint-Petersburg, Russia
Contact: Granov DA, e-mail:

The aspects of vessel reconstruction in oncological practice are reviewed in the article.

Introduction. The relevance of the problem is determined by increase number of neglected malignant tumors in patients with severe co-morbidity.

The objective. To improve the radicality of surgery as step of combined modality treatment due to application of great vessel reconstruction and to increase number of operable patients, to optimize the cytoreduction, to improve quality of live in cancer patients with co-morbidity of great vessels of extremities.

Material and methods. We analyzed surgical outcomes in 377 patients with cancer of biliary-pancreaticoduodenal area (BPA) and in 622 patients with locally advanced renal cancer, who received treatment in Russian Research Center of Radiology and Surgical Techniques in the period from 2006 to 2012.

Results. The great vessel reconstruction was required in 54 (14.3%) patientswith BPA cancer and in 46 (7.4%) with renal cancer. Lower extremities revascularization was performed in 111 cases in the setting of sustained remission. For great vessel reconstruction in patients with BPA cancer the intraoperative mortality rate was 0%. 1-year survival rate – 38 (70.4%) cases. The long-term outcomes corresponded to survival rates in patients with appropriate stage of disease but without involvement of great vessels of BPA.

The reconstruction of vena cava inferior for locally advanced renal cancer was complicated in 1 (2.1%) case by pulmonary embolism (the open pulmonary thromboembolectomy was performed). The mortality rate was – 0%. 1-year survival rate – 39 (84.7%) patients.

The hospital mortality for reconstruction of great arteries of low extremities in cancer patients was – 0%. The complications accounted for 3 (2.7 %) wound infections. The long-term outcomes were matched with non-cancer patients. It must be emphasized that 32 cancer patients with sustained remission had stenting of abdominal aneurism. There were no complications. The hospital mortality was 0%.

Conclusion. The use of vessel reconstructions in oncological practice allows:

  1. To extend the group of patients in which radical surgery is possible.
  2. To improve cytoreduction, which increase the benefit from combined modality treatment for locally-advanced cancer.
  3. To improve quality of life in cancer patients.

KEY WORDS: reconstruction of great vessel, liver cancer, pancreatic cancer, renal cancer, atherosclerosis.

References

  1. Merabishvili VM. Malignant tumors in the world, Russia, Sankt-Peterburge. SPb. 2007; 37-153.
  2. Hemming AW, Reed MA, Langham MR, et al. Combined resection of the liver and inferior vena cava for hepatic malignancy. Ann Surg. 2004; 239: 712-721.
  3. Garcea G, Lloydb TD, Aylottb C, et al. The emergent role of focal liver ablation techniques in the treatment of primary and secondary liver tumours. Eur J Cancer. 2003; 39: 2150-216.
  4. Patyutko Yu.I., Kotelnikov A.G., Kosyirev V.Yu., Sagaydak I.V. Ways to improve the portability gastropancreatoduodenectomy resection. Khirurgiya. 2002; 10: 29-32
  5. Douglas BE. Resectable pancreatic cancer: The role for neoadjuvant preoperative therapy. HPB. 2006; 8: 365-368.
  6. Oldhafer KJ, Lang H, Schlitt HJ, et al. Long-term experience after ex situ liver surgery. Surgery. 2000; 127(5): 521.
  7. Peter J, Lodge A, Ammori Basil J, et al. Ex vivo and in situ resection of inferior vena cava with hepatectomy for colorectal metastases. Ann Surg. 2004; 231 (4): 471-479.
  8. Raab R, Schlitt HJ, Oldhafer KJ, et al. Ex-vivo resection techniques in tissue-preserving surgery for liver malignancies. Arch Surg. 2000; 385: 179-184.
  9. Davydov MI, Matveev VB. Surgical treatment of patients with renal cell carcinoma with tumor thrombosis of the renal vein and inferior vena. Onkourologiya. 2005; 2: 8-15.
  10. Pereverzev AS. Tumor surgery kidney and upper urinary tract. Khar'kov. 1997; 21-35.

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