Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 21, 2022; 10(3): 811-819
Published online Jan 21, 2022. doi: 10.12998/wjcc.v10.i3.811
Management of retroperitoneal sarcoma involving the iliac artery: Single-center surgical experience
Wen-Xiang Li, Han-Xing Tong, Chen-Tao Lv, Hua Yang, Gang Zhao, Wei-Qi Lu, Yong Zhang
Wen-Xiang Li, Chen-Tao Lv, Hua Yang, Department of General Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai 200083, China
Han-Xing Tong, Gang Zhao, Wei-Qi Lu, Yong Zhang, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Author contributions: Li WX and Tong HX collected the data and performed statistical analyses; Lv CT and Yang H prepared the figures and tables; Li WX wrote the paper; Zhang Y, Zhao G, and Lu WQ were responsible for designing the study, critically reviewed the article, and approved the final version of the article to be published.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Zhongshan Hospital, Fudan University.
Informed consent statement: Written informed consent for inclusion in our database was obtained from all patients.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong Zhang, PhD, Chief Doctor, Department of General Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai 200032, China. 13681971072@163.com
Received: June 9, 2021
Peer-review started: June 9, 2021
First decision: June 25, 2021
Revised: September 15, 2021
Accepted: December 22, 2021
Article in press: December 22, 2021
Published online: January 21, 2022
Processing time: 219 Days and 21.9 Hours
ARTICLE HIGHLIGHTS
Research background

Management of retroperitoneal sarcoma (RPS) involving the iliac artery is challenging and requires the concerted efforts of MDT members. Complete tumor resection together with iliac artery reconstruction can confer an outcome advantage for patients.

Research motivation

The retroperitoneal soft tissue tumor MDT of our hospital focuses on the standardized treatment of retroperitoneal sarcoma and has accumulated considerable experience in the surgical treatment of major involved vessels. Therefore, many typical cases and surgeries need to be further summarized and shared to improve the standardized treatment of RPS.

Research objectives

To summarize the clinicopathological features of patients who received RPS excision and iliac artery reconstruction and share our surgical experience in the management of the involved iliac artery.

Research methods

A retrospective analysis of a maintained database consisting of 15 consecutive patients with RPS invading the iliac artery in our center from July 2004 to June 2020 was conducted. Information on baseline characteristics, type of vascular reconstruction, combined number of excised organs, volume of intraoperative blood loss and transfusion, postoperative pathology, and complications was retrieved.

Research results

Fifteen patients were enrolled in this study and received complete tumor resection (R0/R1) with iliac artery reconstruction. No serious complications occurred, and there were no perioperative deaths. Resection with bilateral iliac artery reconstruction required more intraoperative blood transfusions than resection with unilateral iliac artery reconstruction. Recurrent cases were more likely to bleed and required more blood transfusion volume than primary cases. As of January 2021, 11 patients were alive, and 4 patients had died. Local recurrence occurred in two patients.

Research conclusions

Resection of RPS involving iliac vessels is feasible and effective when performed in collaboration with members of a multidisciplinary team (MDT) to ensure the best survival outcomes. Iliac artery oncovascular resection and reconstruction are key to a successful operation. Adequate blood preparation is important for the successful completion of surgery. However, for some highly malignant RPSs, survival remains poor despite vascular reconstruction.

Research perspectives

Additional studies with large samples are needed to calculate survival and recurrence rates and to analyze related risk factors for patients who undergo tumor resection with iliac artery reconstruction.