Concomitant vascular procedures for malignancies with vascular invasion

Hypothesis: Contemporary reconstructive vascular techniques can be safely used to permit resection of tumors invading major vascular structures. Design: Review of vascular surgery registry between January 1, 1987, and December 3,1, 2001. Setting: An academic medical center and affiliated institutions. Patients: Forty-nine patients (37 males and 12 females) aged 15 through 80 years (mean age, 55 years) who required concomitant vascular resection and reconstruction to allow complete tumor resection. Main Outcome Measures: Early (<30 days) morbidity and mortality, late (>30 days) vascular morbidity and mortality, primary patency of the vascular reconstruction, and tumor-free survival. Results: Aortic resection with graft reconstruction was performed in 20 patients (41.7%) and inferior vena cava resection with reconstruction in 6 patients (12.5%). Five patients (10.4%) had both the aorta and inferior vena cava resected and reconstructed. Iliac, femoral, or popliteal reconstructions were performed in 15 patients (31.3%). Portal vein reconstruction was performed to permit resection of pancreatic neoplasms in 8 patients (16.7%). Resection and reconstruction of either a brachiocephalic vessel or superior vena cava was performed in 4 patients. Thirty-day mortality was 2.1%, as 1 patient died of a myocardial infarction following tumor resection with vascular reconstruction. Overall 30-day morbidity was 12.2%. Early vascular morbidity included bleeding from an arterial anastomosis and a compartment syndrome requiring fasciotomy. Primary patency of the vascular reconstructions at 24 months was 90% and tumor-free survival was 70%. Thirty-one patients (63%) were alive, without tumor recurrence and with a patent vascular reconstruction at 24 months. No patient died or lost a limb due to occlusion of the vascular reconstruction. Conclusion: Contemporary reconstructive vascular procedures permit resection of tumors that involve major vascular structures with acceptable early and late morbidity and mortality.