N. Malik1, E.Z. Keung1, C.P. Scally1, K.K. Hunt1, K.E. Torres1, H.A. Lillemoe1, C.L. Roland1, H.G. Lyu1 1University Of Texas MD Anderson Cancer Center, Surgical Oncology, Houston, TX, USA
Introduction:
Retroperitoneal leiomyosarcomas are aggressive malignancies originating in the smooth muscle tissues, most often veins, of the retroperitoneal space. Complete surgical resection with negative margins is crucial to decrease the risk of recurrence but can be risky due to extensive vascular involvement. It is essential to tailor vascular management to a patient’s anatomy to minimize intraoperative blood loss, ensure adequate margins, and reduce adverse postoperative outcomes. Patients may undergo vein reconstruction versus ligation, both of which have significant long-term effects after surgery. The aim of our study was to evaluate the different approaches to IVC and renal vein management and their impact on postoperative complications.
Methods:
We performed a retrospective review of patients who underwent surgery for retroperitoneal leiomyosarcoma with IVC and/or renal vein involvement at our institution from 2016 to 2024. Patients were stratified by intraoperative vascular management including ligation only versus varying forms of vascular reconstruction. Post-operative complications including bleeding, transfusions, need for acute and chronic hemodialysis, and thromboembolic events were recorded. Chi-squared tests were used to compare rates of postoperative complications by vascular management. A p-value of 0.05 was considered statistically significant.
Results:
We identified 60 patients at our institution who underwent surgery for leiomyosarcoma with IVC and/or renal vein involvement. 10 patients underwent IVC ligation alone due to thrombosis, thirty-six had IVC replacement, and fourteen had patch angioplasty. 22 patients had renal vein involvement, with thirteen undergoing renal vein ligation and nine having vascular reconstruction. In the entire cohort, twenty-six patients (43.3%) experienced an adverse event after surgery. When looking at post-operative adverse events by IVC management, we did not find any statistically significant differences among rates of adverse events by group. There were also no statistically significant differences in complications following renal vein ligation versus renal vein reconstruction (Table 1).
Conclusion:
Patients with leiomyosarcoma with IVC and/or renal vein involvement have several options for intraoperative vascular management. Our data demonstrates that there are no statistically significant differences in rates of complications among the different groups. This evidence supports the need for a tailored approach to intraoperative vascular management and to consider ligation when anatomically feasible. Larger, multi-institutional studies are warranted.