Major vascular reconstruction in colorectal adenocarcinoma and retroperitoneal sarcoma: A retrospective study of safety and margins in a tertiary referral centre. (December 2022)

• Record Type: Journal Article
• Authors: Apte, Sameer S.; Cohen, Lauren CL.; Larach, Jose T.; Mohan, Helen M.; Snow, Hayden A.; Wagner, Timothy; McCormick, Jacob J.; Warrier, Satish K.; Gyorki, David E.; Waters, Peadar S.; Heriot, Alexander G.
• Is Part Of: Surgical oncology. Volume 45(2023)
• Publication Date: 2022-12
• Subjects: MeSH): colorectal cancer -- Colorectal adenocarcinoma -- Retroperitoneal sarcoma -- Vascular reconstruction -- Pelvic exenteration; Cancer -- Surgery -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Electronic journals; 616.994059
• DOI: 10.1016/j.suronc.2022.101871
• Languages: English
• ISSNs: 0960-7404

Abstract

Abstract: Background: The role of en bloc vascular resection and reconstruction (EVRR) is controversial in colorectal adenocarcinoma (CRC), but well-established in retroperitoneal sarcoma (RPS). Sparse data exists regarding these complex procedures. Methods: Patients undergoing curative intent EVRR for advanced CRC and RPS between 2014 and 2021 at a tertiary centre were included. Morbidity, margins, recurrence, and survival were evaluated. Results: 24 patients underwent EVRR with 48 reconstructions (11 CRC and 13 RPS). For CRC, 100% of patients underwent Iliac system reconstructions. For RPS, inferior vena cava reconstructions were the most common (69.2%). There were 2 arterial and 1 venous graft thromboses. Primary graft patency was 89.4% arterial and 93.1% venous, while secondary patency was 100% arterial and 96.5% venous at last follow up. 1 venous and 1 arterial graft required reoperation for bleeding. There were no compromised limbs. Major complications occurred in 6 patients (25.0%) with no observed difference between CRC and RPS (OR 0.43 95%CI[0.60, 3.19], P = 0.41). R1 margins occurred 1 CRC (90.9%) and 3 RPS (76.9%), with no R2 resections. All vascular resection margins were clear. There were 6 CRC (50%) and 4 RPS (33.3%) recurrences. Median recurrence time was 20.9 months for CRC and 'not yet reached' for RPS. Median follow-up was 19.4 months for CRC and 21.4 months for RPS. Conclusion: EVRR for locally advanced CRC or RPS is safe and achieves favorable R0 resection rates. CRC patients with major vascular invasion can still be considered for curative intent surgery. Larger cohorts with longer follow up are needed to assess oncologic outcomes. Highlights: Vascular reconstruction is well-accepted for sarcoma but not colorectal cancer. Oncologic enbloc vascular resection & reconstruction safely achieves R0 margins. Oncologic vascular resection & reconstruction is an option in colorectal cancer. Referral to a centre with experience in oncologic vascular resection is crucial.