Resection of retroperitoneal sarcoma en-bloc with inferior vena cava: 20 year outcomes of a single institution

Alex B. Blair, Bradley N. Reames, Jasvinder Singh, Faiz Gani, Heidi N. Overton, Robert J. Beaulieu, Ying Wei Lum, James Hamilton Black, Fabian Johnston, Nita Ahuja

Research output: Contribution to journalArticle

Abstract

Background: Margin negative resection offers the best chance of long-term survival in retroperitoneal sarcoma (RPS). En-bloc resection of adjacent structures, including the inferior vena cava (IVC), is often required to achieve negative margins. We review our 20-year experience of en-bloc IVC and RPS resection. Methods: Retrospective review of patients with RPS resection involving the IVC were matched 1:3 by age and histology to RPS without IVC resection. Prognostic factors for overall survival (OS) and disease free survival (DFS) were assessed. Results: Thirty-two patients underwent RPS resection en-bloc with IVC. They were matched with 96 cases of RPS without IVC resection. Median OS of 59 months and DFS 18 months in IVC resection group was comparable to RPS resection without vascular involvement: median OS 65 months, DFS 18 months (P = 0.519, P = 0.604). On multivariate analyses, R2 margin (OS: HR = 6.52 [95%CI: 1.18-36.09], P = 0.032) was associated with inferior OS. R2 margin and increased number of organs resected (DFS: HR = 5.07, [1.15-22.27], P = 0.031, HR = 1.28 [1.01-1.62], P = 0.014) were associated with inferior DFS. Reconstructions included graft (n = 19, 59%), patch (n = 4, 13%), primary repair (n = 6, 19%), and ligation (n = 4, 13%). Conclusions: RPS resection en-bloc with IVC can achieve equivalent rates of DFS and OS to patients without vascular involvement.

Original languageEnglish (US)
Pages (from-to)127-137
Number of pages11
JournalJournal of Surgical Oncology
Volume118
Issue number1
DOIs
StatePublished - Jul 1 2018

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Inferior Vena Cava
Sarcoma
Disease-Free Survival
Survival
Blood Vessels
Ligation
Histology
Multivariate Analysis
Transplants

Keywords

  • inferior vena cava
  • sarcoma
  • survival
  • vascular resection

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Resection of retroperitoneal sarcoma en-bloc with inferior vena cava : 20 year outcomes of a single institution. / Blair, Alex B.; Reames, Bradley N.; Singh, Jasvinder; Gani, Faiz; Overton, Heidi N.; Beaulieu, Robert J.; Lum, Ying Wei; Black, James Hamilton; Johnston, Fabian; Ahuja, Nita.

In: Journal of Surgical Oncology, Vol. 118, No. 1, 01.07.2018, p. 127-137.

Research output: Contribution to journalArticle

Blair, Alex B. ; Reames, Bradley N. ; Singh, Jasvinder ; Gani, Faiz ; Overton, Heidi N. ; Beaulieu, Robert J. ; Lum, Ying Wei ; Black, James Hamilton ; Johnston, Fabian ; Ahuja, Nita. / Resection of retroperitoneal sarcoma en-bloc with inferior vena cava : 20 year outcomes of a single institution. In: Journal of Surgical Oncology. 2018 ; Vol. 118, No. 1. pp. 127-137.
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title = "Resection of retroperitoneal sarcoma en-bloc with inferior vena cava: 20 year outcomes of a single institution",
abstract = "Background: Margin negative resection offers the best chance of long-term survival in retroperitoneal sarcoma (RPS). En-bloc resection of adjacent structures, including the inferior vena cava (IVC), is often required to achieve negative margins. We review our 20-year experience of en-bloc IVC and RPS resection. Methods: Retrospective review of patients with RPS resection involving the IVC were matched 1:3 by age and histology to RPS without IVC resection. Prognostic factors for overall survival (OS) and disease free survival (DFS) were assessed. Results: Thirty-two patients underwent RPS resection en-bloc with IVC. They were matched with 96 cases of RPS without IVC resection. Median OS of 59 months and DFS 18 months in IVC resection group was comparable to RPS resection without vascular involvement: median OS 65 months, DFS 18 months (P = 0.519, P = 0.604). On multivariate analyses, R2 margin (OS: HR = 6.52 [95{\%}CI: 1.18-36.09], P = 0.032) was associated with inferior OS. R2 margin and increased number of organs resected (DFS: HR = 5.07, [1.15-22.27], P = 0.031, HR = 1.28 [1.01-1.62], P = 0.014) were associated with inferior DFS. Reconstructions included graft (n = 19, 59{\%}), patch (n = 4, 13{\%}), primary repair (n = 6, 19{\%}), and ligation (n = 4, 13{\%}). Conclusions: RPS resection en-bloc with IVC can achieve equivalent rates of DFS and OS to patients without vascular involvement.",
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T1 - Resection of retroperitoneal sarcoma en-bloc with inferior vena cava

T2 - 20 year outcomes of a single institution

AU - Blair, Alex B.

AU - Reames, Bradley N.

AU - Singh, Jasvinder

AU - Gani, Faiz

AU - Overton, Heidi N.

AU - Beaulieu, Robert J.

AU - Lum, Ying Wei

AU - Black, James Hamilton

AU - Johnston, Fabian

AU - Ahuja, Nita

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Background: Margin negative resection offers the best chance of long-term survival in retroperitoneal sarcoma (RPS). En-bloc resection of adjacent structures, including the inferior vena cava (IVC), is often required to achieve negative margins. We review our 20-year experience of en-bloc IVC and RPS resection. Methods: Retrospective review of patients with RPS resection involving the IVC were matched 1:3 by age and histology to RPS without IVC resection. Prognostic factors for overall survival (OS) and disease free survival (DFS) were assessed. Results: Thirty-two patients underwent RPS resection en-bloc with IVC. They were matched with 96 cases of RPS without IVC resection. Median OS of 59 months and DFS 18 months in IVC resection group was comparable to RPS resection without vascular involvement: median OS 65 months, DFS 18 months (P = 0.519, P = 0.604). On multivariate analyses, R2 margin (OS: HR = 6.52 [95%CI: 1.18-36.09], P = 0.032) was associated with inferior OS. R2 margin and increased number of organs resected (DFS: HR = 5.07, [1.15-22.27], P = 0.031, HR = 1.28 [1.01-1.62], P = 0.014) were associated with inferior DFS. Reconstructions included graft (n = 19, 59%), patch (n = 4, 13%), primary repair (n = 6, 19%), and ligation (n = 4, 13%). Conclusions: RPS resection en-bloc with IVC can achieve equivalent rates of DFS and OS to patients without vascular involvement.

AB - Background: Margin negative resection offers the best chance of long-term survival in retroperitoneal sarcoma (RPS). En-bloc resection of adjacent structures, including the inferior vena cava (IVC), is often required to achieve negative margins. We review our 20-year experience of en-bloc IVC and RPS resection. Methods: Retrospective review of patients with RPS resection involving the IVC were matched 1:3 by age and histology to RPS without IVC resection. Prognostic factors for overall survival (OS) and disease free survival (DFS) were assessed. Results: Thirty-two patients underwent RPS resection en-bloc with IVC. They were matched with 96 cases of RPS without IVC resection. Median OS of 59 months and DFS 18 months in IVC resection group was comparable to RPS resection without vascular involvement: median OS 65 months, DFS 18 months (P = 0.519, P = 0.604). On multivariate analyses, R2 margin (OS: HR = 6.52 [95%CI: 1.18-36.09], P = 0.032) was associated with inferior OS. R2 margin and increased number of organs resected (DFS: HR = 5.07, [1.15-22.27], P = 0.031, HR = 1.28 [1.01-1.62], P = 0.014) were associated with inferior DFS. Reconstructions included graft (n = 19, 59%), patch (n = 4, 13%), primary repair (n = 6, 19%), and ligation (n = 4, 13%). Conclusions: RPS resection en-bloc with IVC can achieve equivalent rates of DFS and OS to patients without vascular involvement.

KW - inferior vena cava

KW - sarcoma

KW - survival

KW - vascular resection

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