Sarcoma resection with and without vascular reconstruction: A matched case-control study

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

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)632-640
Number of pages9
JournalAnnals of Surgery
Volume262
Issue number4
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

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Sarcoma
Blood Vessels
Case-Control Studies
Survival
Histology
Morbidity
Recurrence
Mortality
Veins
Arteries
Neoplasm Metastasis

Keywords

  • Morbidity
  • Mortality
  • Outcome
  • Recurrence
  • Sarcoma
  • Survival
  • Vascular reconstruction
  • Vascular resection

ASJC Scopus subject areas

  • Surgery

Cite this

Poultsides, G. A., Tran, T. B., Zambrano, E., Janson, L., Mohler, D. G., Mell, M., ... Norton, J. A. (2015). Sarcoma resection with and without vascular reconstruction: A matched case-control study. Annals of Surgery, 262(4), 632-640. https://doi.org/10.1097/SLA.0000000000001455

Sarcoma resection with and without vascular reconstruction : A matched case-control study. / Poultsides, George A.; Tran, Thuy B.; Zambrano, Eduardo; Janson, Lucas; Mohler, David G.; Mell, Matthew; Avedian, Raffi S.; Visser, Brendan C.; Lee, Jason T.; Ganjoo, Kristen; Harris, E. John; Norton, Jeffrey A.

In: Annals of Surgery, Vol. 262, No. 4, 01.01.2015, p. 632-640.

Research output: Contribution to journalArticle

Poultsides, GA, Tran, TB, Zambrano, E, Janson, L, Mohler, DG, Mell, M, Avedian, RS, Visser, BC, Lee, JT, Ganjoo, K, Harris, EJ & Norton, JA 2015, 'Sarcoma resection with and without vascular reconstruction: A matched case-control study', Annals of Surgery, vol. 262, no. 4, pp. 632-640. https://doi.org/10.1097/SLA.0000000000001455
Poultsides, George A. ; Tran, Thuy B. ; Zambrano, Eduardo ; Janson, Lucas ; Mohler, David G. ; Mell, Matthew ; Avedian, Raffi S. ; Visser, Brendan C. ; Lee, Jason T. ; Ganjoo, Kristen ; Harris, E. John ; Norton, Jeffrey A. / Sarcoma resection with and without vascular reconstruction : A matched case-control study. In: Annals of Surgery. 2015 ; Vol. 262, No. 4. pp. 632-640.
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abstract = "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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AU - Poultsides, George A.

AU - Tran, Thuy B.

AU - Zambrano, Eduardo

AU - Janson, Lucas

AU - Mohler, David G.

AU - Mell, Matthew

AU - Avedian, Raffi S.

AU - Visser, Brendan C.

AU - Lee, Jason T.

AU - Ganjoo, Kristen

AU - Harris, E. John

AU - Norton, Jeffrey A.

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N2 - 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.

AB - 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.

KW - Morbidity

KW - Mortality

KW - Outcome

KW - Recurrence

KW - Sarcoma

KW - Survival

KW - Vascular reconstruction

KW - Vascular resection

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