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Vascular Reconstruction in the Resection of Soft Tissue Sarcomas

University of CA, Davis-East Bay Department of Surgery (Vascular), Kaiser Medical Center, Oakland, CA

To-Nao Wang, M.D.

Department of Surgery (Plastic Surgery), Kaiser Medical Center-Oakland, CA

Richard J. O'Donnell, M.D.

Musculoskeletal Oncology Department-Kaiser South San Francisco

P.T. Mcdonald, M.D.

University of CA, Davis-East Bay Department of Surgery (Vascular), Kaiser Medical Center, Oakland, CA

Steven G. Granelli, M.D.

University of CA, Davis-East Bay Department of Surgery (Surgical Oncology), Kaiser Medical Center, Oakland, CA

As the specialty of vascular surgery evolves, vascular surgeons may be asked to assist in the management of patients with locally invasive sarcomas that may require vascular resection or reconstruction.

Since July 1, 1996, we have surgically treated 165 patients with sarcoma. Of these, 11 were considered preoperatively to have potential vascular involvement, with 3 ultimately requiring vascular reconstruction or ligation (Table I). An additional patient with a recurrent nonseminomatous germ cell tumor of the pelvis is included because the natural history reflects that of sarcoma, and the surgical management illustrates important technical points regarding en bloc resection and vascular reconstruction. Patient age ranged from 11 to 75 (mean 46). No patients have been lost to follow-up, which has ranged from 1 to 32 months (mean 13.4 months). Four patients had recurrent tumors during follow-up. Those with the smallest tumors and those not requiring vascular reconstruction had the highest rates of cure to date. There was one death in a 32-year-old female with a large thigh leiomyosarcoma who developed pulmonary metastasis 1 year postoperatively

Four patients required vascular reconstruction. One (patient 2, Table 1) with a metastatic malignant histiocytoma of the groin had persistent disease due to inability to obtain a clear surgical margin. She had refused hip disarticulation. Another (patient 1, Table 1) developed a duodenal recurrence at 1.5 years. He underwent a Whipple resection and is disease-free at 4 months. The remaining two are disease-free at last follow-up.

There were no perioperative deaths. One patient developed a groin wound infection 2 weeks postoperatively that required removal of a proximal superficial femoral artery PTFE interposition graft and common femoral venous interposition graft. Viability of the limb was maintained via profunda collateral, and amputation has not been required. One patient with a prosthetic iliac vein bypass developed a proximal anastomotic stenosis at 3 months, which was successfully treated with balloon angioplasty and stent placement. Repeat angioplasty was required 1 year later, and he subsequently remains asymptomatic at 8 months.

Herein we present the lessons learned in our experience with this unique population of patients. Successful outcome for these cases requires extensive preoperative planning and collaboration among all physicians involved in the patient's care.

Key Words: Sarcoma • cancer • multimodel therapy • vascular reconstruction

Perspectives in Vascular Surgery and Endovascular Therapy, Vol. 12, No. 2, 67-83 (2000)
DOI: 10.1177/153100350001200214


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