VESS24. Outcome of Peripheral Venous Reconstructions During Tumor Resection

Abstract

Peripheral venous reconstruction surgery may be necessary for appropriate oncological resection. However, the operative approach and surgical outcomes are not well described. We sought to report our experience with these complex reconstructions to identify best practice. We retrospectively reviewed all adult patients who underwent peripheral vein reconstruction for tumor resection at Mayo Clinic, Rochester (2000-2015). Patients were classified into three subgroups based on the location: iliac (IL), lower extremity (LE), and upper extremity (UE). Location, type of reconstruction, operative morbidity, long-term patency, limb salvage, recurrence, and mortality were recorded. A total of 31 patients (14 female and 17 male; mean age, 56 ± 15) underwent vein reconstruction during tumor resection, and 17 (55%) required concomitant artery reconstruction. The most commonly treated tumors were liposarcoma (n = 4), rectal cancer (n = 4), and leiomyosarcoma (n = 3). Reconstructions were IL in 21 (68%), LE in 6 (19%) and UE in 4 (13%). Venous reconstructions consisted of 7 vein grafts (23%), 20 polytetrafluoroethylene (PTFE) prosthetic grafts (65%), 1 cryograft (3%), and 3 isolated patch angioplasties (10%). There were two additional patch angioplasty procedures in conjunction with vein grafts (1 PTFE, 1 cryograft). There were no in-hospital deaths. The mean length of hospital stay was 13.1 ± 10.2 days, with discharge medications of aspirin for 16 patients (52%) and Coumadin for 18 (58%). Surgical complications included renal failure (n = 6), respiratory complication (n = 4), surgical site infection (n = 9), graft infection (n = 3), and lymph leak (n = 7). The median follow-up was 4.0 years (range, 17 days-14.1 years). Overall primary patency at 2 and 5 years was 66% (95% confidence interval [CI], 48%-89%) and 59% (95% CI, 36%-86%), and overall freedom from graft thrombosis was 88% (95% CI, 73%-100%) and 79% (95% CI, 55%-100%; Table). Five patients (13%) experienced graft thrombosis (3 IL, 1 LE, 1 UE), of which four were prosthetic and one was a patch site. These were managed by thrombolysis (n = 1), thrombectomy (n = 1), and medical management (n = 3). Two patients (6.5%) underwent ipsilateral amputation (at 3 and 314 days for compartment syndrome and metastatic pain). The 2- and 5-overall survival rate was 76% (95% CI, 60%-95%) and 60% (95% CI, 41%-85%). Death was predominantly from cancer-associated morbidities. Overall 2- and 5-year recurrence-free survival was 64% (95% CI, 47%-86%) and 49% (95% CI, 30%-75%), respectively (Table). In selected patients fit for advanced tumor resection, construction of iliac and extremity veins is a safe and durable with excellent limb salvage. Both vein and prosthetic reconstructions appear effective. However, infectious complications and graft thrombosis remain important complications when selecting prosthetic conduit.TableVariableNo. (N = 31)2-year primary patency2-year freedom graft thrombosisSurvival2-year disease-free survival% (95% CI)% (95% CI)% (95% CI)% (95% CI)Iliac2163.0 (40.0-86.0)81.9 (63.1-100)69.0 (46.8-91.2)63.0 (42.6-91.6)Lower extremity666.7 (20.7-100)100 (91.7-100)80.0 (39.7-100)66.7 (32.1-100)Upper extremity466.7 (8.0-100)100 (87.5-100)100 (87.5-100)66.7 (30.0-100)CI, Confidence interval. Open table in a new tab