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Sarcoma Resection With and Without Vascular Reconstruction: A Matched Case-control Study

Poultsides, George A. MD*; Tran, Thuy B. MD*; Zambrano, Eduardo MD; Janson, Lucas MS; Mohler, David G. MD§; Mell, Matthew W. MD; Avedian, Raffi S. MD§; Visser, Brendan C. MD*; Lee, Jason T. MD; Ganjoo, Kristen MD||; Harris, E. John MD; Norton, Jeffrey A. MD*

doi: 10.1097/SLA.0000000000001455
ASA Papers

Objective: To examine the impact of major vascular resection on sarcoma resection outcomes.

Summary Background Data: En bloc resection and reconstruction of involved vessels is being increasingly performed during sarcoma surgery; however, the perioperative and oncologic outcomes of this strategy are not well described.

Methods: Patients undergoing sarcoma resection with (VASC) and without (NO-VASC) vascular reconstruction were 1:2 matched on anatomic site, histology, grade, size, synchronous metastasis, and primary (vs. repeat) resection. R2 resections were excluded. Endpoints included perioperative morbidity, mortality, local recurrence, and survival.

Results: From 2000 to 2014, 50 sarcoma patients underwent VASC resection. These were matched with 100 NO-VASC patients having similar clinicopathologic characteristics. The rates of any complication (74% vs. 44%, P = 0.002), grade 3 or higher complication (38% vs. 18%, P = 0.024), and transfusion (66% vs. 33%, P < 0.001) were all more common in the VASC group. Thirty-day (2% vs. 0%, P = 0.30) or 90-day mortality (6% vs. 2%, P = 0.24) were not significantly higher. Local recurrence (5-year, 51% vs. 54%, P = 0.11) and overall survival after resection (5-year, 59% vs. 53%, P = 0.67) were similar between the 2 groups. Within the VASC group, overall survival was not affected by the type of vessel involved (artery vs. vein) or the presence of histology-proven vessel wall invasion.

Conclusions: Vascular resection and reconstruction during sarcoma resection significantly increases perioperative morbidity and requires meticulous preoperative multidisciplinary planning. However, the oncologic outcome appears equivalent to cases without major vascular involvement. The anticipated need for vascular resection and reconstruction should not be a contraindication to sarcoma resection.

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*Department of Surgery, Division of Surgical Oncology, Stanford University, Stanford, CA

Department of Pathology, Stanford University, Stanford, CA

Department of Statistics, Stanford University, Stanford, CA

§Department of Orthopaedic Surgery, Stanford University, Stanford, CA

Department of Surgery, Division of Vascular Surgery, Stanford University, Stanford, CA

||Department of Medicine, Division of Oncology, Stanford University, Stanford, CA.

Reprints: George A. Poultsides, MD, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, H3680D, Stanford, CA 94305-5641. E-mail: gpoultsides@stanford.edu.

Disclosure: The authors report no conflicts of interest.

Presented at the 135th Annual Meeting of the American Surgical Association, San Diego, CA, April 23–25, 2015.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (www.annalsofsurgery.com).

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