The Impact of Vascular Management on Postoperative Complications in Patients Undergoing Surgery for Retroperitoneal Leiomyosarcoma

TL;DR

This study found that different ways surgeons handle blood vessels during retroperitoneal leiomyosarcoma surgery do not significantly affect postoperative complications.

Contribution

The study provides new evidence that vascular management techniques do not influence complication rates in this specific cancer surgery.

Findings

No significant differences in complications were found between IVC ligation and reconstruction methods.

Renal vein ligation and reconstruction also showed no significant difference in complication rates.

43.3% of patients experienced postoperative adverse events regardless of vascular management approach.

Abstract

Retroperitoneal sarcomas are an aggressive form of cancer that may involve major blood vessels in the abdomen. Our study looked at how surgeons managed involved blood vessels and whether that impacted complications after surgery. We found that there were no significant differences in the rates of complications after surgery when looking at how the involved blood vessels were managed.

Background: Retroperitoneal leiomyosarcomas are aggressive malignancies. Complete surgical resection with negative margins is crucial to decrease the risk of recurrence but can be risky due to vascular involvement. 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. Postoperative complications, including bleeding, transfusions, the 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. Ten patients underwent IVC ligation alone due to thrombosis, thirty-six had IVC replacement, and fourteen had patch angioplasty. In the entire cohort, twenty-six patients (43.3%) experienced an adverse event after surgery. When looking at postoperative 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. Conclusions: 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.