Contemporary approach to surgical treatment of retroperitoneal sarcomas involving major vessels (a literature review)

• Kit O.I.
• Gevorkyan Yu.A.
• Katelnitskaya O.V.

Abstract

Currently, radical removal of retroperitoneal sarcoma is the only method of treatment, making it possible to increase survival of oncological patients. Operative interventions for retroperitoneal tumors frequently require widening of the scope of surgery at the expense of resection of cancer-involved organs and structures, including major vessels.

The article is a review of literature searched in the PubMed database. Publications were retrieved using various combinations of terms: «retroperitoneal tumor», «retroperitoneal sarcoma», «vascular resection», «vein resection». The analysis included articles over the last 20 years, based on original studies demonstrating the results of surgical treatment of malignant retroperitoneal tumors involving major vessels.

We analysed 19 contemporary studies including a total of 472 patients with retroperitoneal tumors and lesions of major vessels. In retroperitoneal sarcomas, prosthetic repair using a synthetic graft is considered to be the most common method of vascular reconstruction. Widening the scope of the operative intervention at the expense of resection of major vessels made it possible to perform microscopically complete removal of the tumor in approximately 60% of patients, with the frequency of macroscopically incomplete resection amounting to 16%. The postoperative complication and mortality rates averagely amounted to 32.4% and 2.5%, respectively. The remote oncological results reliably did not differ in patients with and without lesions of major vessels. In removing retroperitoneal tumors with resection of major vessels, the overall 5-year survival rate varied from 21 to 66%, with the median overall survival ranging from 29 to 120 months.

Conclusion. A present-day method of treatment for retroperitoneal sarcomas with lesions of major vessels still remains radical removal of the tumor. Widening the scope of the operation at the expense of vascular resection has admissible incidence of postoperative complications and mortality rates. Despite the locally disseminated process, complexity of the surgical procedure, total en bloc removal of the tumor makes it possible to obtain the relapse-free and overall survival rates comparable to those in patients without lesions of major vessels.

Keywords:inferior vena cava; sarcoma; retroperitoneal tumor; vascular resection; vascular reconstructions

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