• 2014
  • 2013
  • 2012
  • 2011
  • 2010
  • 2009
  • 2008

The journal «ONCOSURGERY» 2013, Vol.5, No 4

Surgical excision of retroperitoneal tumors involving great vessels

Tereshin OS, Zotov SP, Zaikov AA

Chelyabinsk Regional Oncological Dispensary, Chelyabinsk, Russia
Contact: Tereshin OS, e-mail:

The treatment results for retroperitoneal tumors intimately attached to great vessels are discussed in the article.

Material and methods. Retrospective analysis of treatment results in 26 patients with primary and recurrent retroperitoneal tumors was performed, 24 patients had en block resection with portion of great vessel or dissection of tumor from vessel in the setting of vessel isolation. Patients underwent treatment and follow-up in Chelyabinsk Regional Oncological Dispensary in the period from 2003 to 2013.

Results. The age of patients accounted from 15 to 75, the average age was 45.7, there were 22 women and 4 men. Non-organ retroperitoneal tumors occurred in 21 cases (80.7%), 5 of them were recurrent and 2 – leiomyosarcomas of vena cava inferior (VCI). One female patient had adrenal carcinoma with extension to retroperitoneal fat. Explorative laparotomy was performed in 2 cases. Complete tumor removal was performed in 24 patients, they were divided into two groups. In group 1 resection of vessel was required for tumor removal. In group 2 the tumor was detached from vessel due to meticulous dissection, subadventitially in several cases. The group 1 included 12 patients, the average age was 41.2 years. In 3 cases the definite diagnosis was neurofibroma in 2 cases – inflammatory retroperitoneal pseudotumor. Aditionally, features of locally aggressive growth required en block resection of vessel with tumor were changed. For this subgroup outcomes were followed during 1.5, 2, 9, 15 and 19 years and were defined as good. Seven patients underwent surgery for malignant tumors. One female patient was dead because of disseminated intravascular coagulation and multiple organ failure in acute post-operative period after resection for leiomyosarcoma of retrohepatic segment of inferior vena cava. For another 6 patients with median follow-up of 22.5 months there were 2 deaths from disease progression, 1 recurrence and 3 remissions. In general there were 10 resections of VCI in group 1, 2 sleeve resections were accomplished by reconstruction with artificial prosthesis, there were 2 resections of common iliac artery with prosthesis and 1 lateral resection of aorta.

The group 2 included 12 patients, the average age was 48.1 years. In 1 case there was benign tumor according to results of histological study of surgical specimen. In the group of 11 patients with malignant tumors 1 patient died from multiple organ failure 1 month after extended surgery. For another 10 patients with median follow-up of 21.2 months 3 local recurrences, 1 disease progression and 2 deaths from progression occurred.

Conclusion. Surgery on great retroperitoneal vessels is adequate in the settings of definitive oncological operation. The need for retroperitoneal vessel resection occurs mostly in patients with non-organ retroperitonal tumors including benign lesions. Intimate attachment of metastatic tumor to great vessel significantly complicates surgery and is defined as poor prognostic factor for local extension. The statistically significant results may be achieved due to creating multicenter database of patients.

KEY WORDS:malignant retroperitoneal tumor, abdominal aorta, inferior vena cava, resection with prosthesis.

References

  1. Kit OI, Kasatkin VF, Maksimov AJu, et al. Surgical treatment for non-organ retroperitoneal tumors. Palliativnaya meditsina i reabilitatsiya, 2012; 1: 27-29.
  2. Kharchenko VP, Chkhivadze VD, Sdvigkov AM. Diagnosis and treatment of retroperitoneal lipomas and liposarcomas. Rossiyskiy onkologicheskiy zhurnal, 2011; 3: 10-15.
  3. Chissov VI, Vashakmadze LA, Butenko AA, et al. Current approaches and prognostic factors for surgical treatment of primary and recurrent non-organ retroperitoneal tumors. Rossiyskiy onkologicheskiy zhurnal, 2011; 3: 4-10.
  4. Zotov SP, Fokin AA. Angiosurgery in oncology. Chelyabinsk. 1999; 118.
  5. Fineshtein IA, Nechushkin MI, Gorobez ES, et al. Resection and prosthesis of abdominal aorta during surgery for locally advanced retroperitoneal tumors. Khirurgiya im. N.N. Pirogova, 2010; 6: 26-30.
  6. Stilidi IS, Gubina GI, Bokhyan VR, et al. Resection and reconstruction of inferior vena cava for retroperitoneal tumors. Annaly khirurgii, 2011; 6: 36-43.
  7. Klimenkov AA, Gubina GI. Non-organ retroperitoneal tumors: main principles of diagnosis and surgical tactics. Prakticheskaya onkologiya, 2004; 5(4): 285-290.
  8. Antipov SV, Kalinin EV, Miroshnichenko PV, et al. Integration surgery for abdominal and retroperitoneal. Onkologiya, 2010; 12(4): 355-358.
  9. Song TK, Harris EJ Jr, Raghavan S, et al. Major blood vessel reconstruction during sarcoma surgery. Arch Surg, 2009; 144: 817-22.
  10. Tseng WW, Wang SC, Eichler CM, et al. Complete and safe resection of challenging retroperitoneal tumors: anticipation of multiorgan and major vascular resection and use of adjunct procedures. World J Surg Oncol, 2011; 9: 143.
  11. Quinones-Baldrich W, Alktaifi A, Eilber F. Inferior vena cava resection and reconstruction for retroperitoneal tumor excision. J Vasc Surg, 2012; 55(5): 1386-93.
  12. Schwarzbach MH, Hormann Y, Hinz U, et al. Clinical results of surgery for retroperitoneal sarcoma with major blood vessel involvement. J Vasc Surg, 2006; 44(1): 46-55.

P. 8-14

Publishers
«Oncokhirurgia Info»

10 Vostochnaia ul., suite 16, Moscow, 115280
Tel./fax: +7(499) 426-46-22
Tel.: +7(915) 356-03-07
E-mail:
URL: oncosurgery.oncology.ru


РСХО