Vascular Reconstruction Increases Morbidity in Sarcoma Resections

Vascular reconstruction and resection increase morbidity in sarcoma patients undergoing resection compared with those who do not undergo vascular procedures, but oncologic outcomes are no different between the two groups, according to a new study.

“Sarcomas… are still in many cases resistant to standard chemotherapy or radiotherapy modalities and surgical resection remains the cornerstone of treatment,” wrote study authors led by George A. Poultsides, MD, of Stanford University School of Medicine in California. “Often, the ability to completely remove the tumor is affected by its relationship to major blood vessels.”

The study aimed to assess whether complex vascular procedures are associated with prolongation of survival that could justify any increased morbidity. The results were published in Annals of Surgery.

Between 2000 and 2014, 50 patients with sarcoma underwent resection with vascular resection or reconstruction, representing 5% of sarcoma resection patients at the study institution; these patients were matched with 100 patients undergoing resection without vascular procedures.

The rate of any complication was higher in the vascular group, at 74% compared with 44% (P = .002). Grade 3 or higher complications were also more common, at 38% vs 18% (P = .024), as was transfusion, at 66% compared with 33% (P < .001).

Short-term mortality outcomes, however, were no different. At 30 days, there was a 2% mortality rate in the vascular group and 0% in the non-vascular group (P = .30). At 90 days, the rates were 6% and 2% (P = .24).

The 5-year local recurrence rate was 51% with vascular resection and 54% without (P = .11), and the overall survival rate at 5 years was 59% with vascular resection and 53% without (P = .67). There was no difference within the vascular resection group with regard to the type of vessel involved or the presence of histology-proven vessel wall invasion.

“The need for vascular resection and reconstruction should not be a deterrent to resection for sarcoma patients, as the oncologic outcome (overall and local recurrence free survival) appears equivalent to matched cases without vascular involvement,” the study authors concluded. “Meticulous multidisciplinary planning and close collaboration between surgical oncologists, orthopedic oncologists, and vascular surgeons is critical for a successful outcome.”