Tactical approaches to vascular reconstruction in retroperitoneal sarcoma surgery

Introduction. In retroperitoneal sarcomas with invasion of the large или major vessels, large-scale multivisceral resections with vascular reconstruction is a technical necessity. Despite the successes of oncovascular surgery, aspects of planning and performance of such surgical interventions remain insufficiently studied. Aim. Retrospective analysis and summary of our own experience of vascular reconstructions in retroperitoneal sarcomas. Materials and methods. The study included 80 patients (median age 52.5 years, 65 % men, 35 % women) who underwent 88 surgical procedures due to primary (35 (39.8 %) cases) and recurrent (53 (30.2 %) cases) tumors. Preoperative planning was based on clinical examination, imaging and morphological verification data with subsequent multidisciplinary discussion. In 44.3 % of cases liposarcomas were diagnosed, in 22.7 % – leiomyosarcomas. Vascular invasion was classified in accordance with the M.H. Schwarzbach et al. (2006) classification. Type I invasion was observed in 15.9 % patients, type II – in 45.5 %, type III – in 39.6 %. Efficacy of preoperative planning, immediate and long-term oncological and vascular surgical results were evaluated. Results. Preoperative diagnostic methods were characterized by high sensitivity but moderate specificity: 94.7 and 68.6 %, respectively (area under the curve (AUC) = 0.712 (95 % confidence interval 0.698–0.811). In 96.6 % of cases, vascular reconstructions were performed as a prosthetic replacement (57 cases), vascular patch plastic (16 cases) or vascular suture (12 cases), and in the arterial invasion group graft interposition was the most common (83.7 % cases). In surgeries on the target vessels, R0 resection was achieved. Radical resection (R0) on the margins of tumor lesion was confirmed in 79 (89.8 %) cases. During long-term observation period, specific vascular complications (thrombosis, occlusion) were reported in 10 (12.05 %) patients. Long-term results of treatment were followed-up in 69 (86.25 %) patients. Follow-up duration varied between 3 and 92 months (median 23 months). Local recurrence developed in 18.8 % of patients after R0 resection and in 85.7% after R1/R2 resection. Tumor progression was verified in 24 (39.3 %) patients. Conclusion. Multivisceral resection with reconstruction of the major vessels in retroperitoneal sarcomas improve survival and decrease the rate of local recurrences. Planning and performance of such procedures require multidisciplinary approach. Despite encouraging results, some fundamental aspects of the problem remain unsolved and necessitate further investigation.