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- W2096596579 abstract "A 57-year-old man underwent resection of an extraosseous osteosarcoma involving the abdominal wall and spermatic cord. He was found by computed tomography (CT) 6 months later to have a new retroperitoneal mass, suspicious for lymph node recurrence involving the inferior vena cava, right ureter, and possibly aorta (A). Metastatic survey including positron emission tomographic scan revealed no other disease. The patient underwent en bloc resection of the tumor including the aorta from the left renal artery to the aortic bifurcation, inferior vena cava from the common iliac vein confluence to the left renal vein, and right kidney and ureter (B, posterior view). The aorta was replaced (C and cover) with a 14 mm diameter collagen coated polyester graft (Intervascular, Midvale, NJ) and the inferior vena cava with an externally supported 16 mm diameter expanded polytetrafluoroethylene graft (W. L. Gore and Associates, Inc, Flagstaff, Ariz). The patient was anticoagulated and never developed signs of lower extremity ischemia or swelling. Postoperative venous duplex scanning revealed no evidence for lower extremity venous thrombosis. Follow-up CT on the 12th postoperative day indicated that both vascular grafts remained patent. However, the patient rapidly developed extensive pulmonary metastases and died on the 105th postoperative day. Extraosseous osteosarcoma is an aggressive malignancy, poorly responsive to chemo- or radiotherapy. 1Ahmad S.A. Patel S.R. Ballo M.T. Baker T.P. Yasko A.W. Wang X. et al.Extraosseous osteosarcoma: response to treatment and long-term outcome.J Clin Oncol. 2002; 20: 521-527Crossref PubMed Scopus (95) Google Scholar Arterial or venous replacement with prosthetic or allografts is sometimes feasible in selected patients with extremity sarcomas. 2Schwarzbach M.H.M. Hormann Y. Hinz U. Bernd L. Willeke F. Mechtersheimer G. et al.Results of limb-sparing surgery with vascular replacement for soft tissue sarcoma in the lower extremity.J Vasc Surg. 2005; 42: 88-97Abstract Full Text Full Text PDF PubMed Scopus (82) Google Scholar However, many consider major blood vessel involvement to be a contraindication to attempts at total excision of retroperitoneal tumors, particularly if both aorta and inferior vena cava are involved. Schwarzbach et al described results in 25 patients requiring major blood vessel resection for retroperitoneal sarcomas. 3Schwarzbach M.H.M. Hormann Y. Hinz U. Leowardi C. Böckler D. Mechtersheimer G. et al.Clinical results of surgery for retroperitoneal sarcoma with major blood vessel involvement.J Vasc Surg. 2006; 44: 46-55Abstract Full Text Full Text PDF PubMed Scopus (131) Google Scholar Nine of 10 patients with negative resection margins survived at least 2 years after resections, but it appears that only one of the entire group of 25 underwent replacement of both the aorta and inferior vena cava. 3Schwarzbach M.H.M. Hormann Y. Hinz U. Leowardi C. Böckler D. Mechtersheimer G. et al.Clinical results of surgery for retroperitoneal sarcoma with major blood vessel involvement.J Vasc Surg. 2006; 44: 46-55Abstract Full Text Full Text PDF PubMed Scopus (131) Google Scholar Our patient had isolated disease without evidence for pulmonary or other metastases. We offered surgery to the patient because long-term survival is possible with resection of isolated metastatic extraosseous osteosarcoma. 1Ahmad S.A. Patel S.R. Ballo M.T. Baker T.P. Yasko A.W. Wang X. et al.Extraosseous osteosarcoma: response to treatment and long-term outcome.J Clin Oncol. 2002; 20: 521-527Crossref PubMed Scopus (95) Google Scholar Both vascular grafts performed well until he died from metastatic disease. Anatomic situations requiring this extensive surgery are rare. However, highly selected patients may be candidates and may benefit from such surgery. Download .jpg (3.63 MB) Help with jpg files Cover Image" @default.
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- W2096596579 title "Combined replacement of infrarenal aorta and inferior vena cava after en bloc resection of retroperitoneal extraosseous osteosarcoma" @default.
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%206%20months%20later%20to%20have%20a%20new%20retroperitoneal%20mass%2C%20suspicious%20for%20lymph%20node%20recurrence%20involving%20the%20inferior%20vena%20cava%2C%20right%20ureter%2C%20and%20possibly%20aorta%20(A).%20Metastatic%20survey%20including%20positron%20emission%20tomographic%20scan%20revealed%20no%20other%20disease.%20The%20patient%20underwent%20en%20bloc%20resection%20of%20the%20tumor%20including%20the%20aorta%20from%20the%20left%20renal%20artery%20to%20the%20aortic%20bifurcation%2C%20inferior%20vena%20cava%20from%20the%20common%20iliac%20vein%20confluence%20to%20the%20left%20renal%20vein%2C%20and%20right%20kidney%20and%20ureter%20(B%2C%20posterior%20view).%20The%20aorta%20was%20replaced%20(C%20and%20cover)%20with%20a%2014%20mm%20diameter%20collagen%20coated%20polyester%20graft%20(Intervascular%2C%20Midvale%2C%20NJ)%20and%20the%20inferior%20vena%20cava%20with%20an%20externally%20supported%2016%20mm%20diameter%20expanded%20polytetrafluoroethylene%20graft%20(W.%20L.%20Gore%20and%20Associates%2C%20Inc%2C%20Flagstaff%2C%20Ariz).%20The%20patient%20was%20anticoagulated%20and%20never%20developed%20signs%20of%20lower%20extremity%20ischemia%20or%20swelling.%20Postoperative%20venous%20duplex%20scanning%20revealed%20no%20evidence%20for%20lower%20extremity%20venous%20thrombosis.%20Follow-up%20CT%20on%20the%2012th%20postoperative%20day%20indicated%20that%20both%20vascular%20grafts%20remained%20patent.%20However%2C%20the%20patient%20rapidly%20developed%20extensive%20pulmonary%20metastases%20and%20died%20on%20the%20105th%20postoperative%20day.%20Extraosseous%20osteosarcoma%20is%20an%20aggressive%20malignancy%2C%20poorly%20responsive%20to%20chemo-%20or%20radiotherapy.%201Ahmad%20S.A.%20Patel%20S.R.%20Ballo%20M.T.%20Baker%20T.P.%20Yasko%20A.W.%20Wang%20X.%20et%20al.Extraosseous%20osteosarcoma%3A%20response%20to%20treatment%20and%20long-term%20outcome.J%20Clin%20Oncol.%202002%3B%2020%3A%20521-527Crossref%20PubMed%20Scopus%20(95)%20Google%20Scholar%20Arterial%20or%20venous%20replacement%20with%20prosthetic%20or%20allografts%20is%20sometimes%20feasible%20in%20selected%20patients%20with%20extremity%20sarcomas.%202Schwarzbach%20M.H.M.%20Hormann%20Y.%20Hinz%20U.%20Bernd%20L.%20Willeke%20F.%20Mechtersheimer%20G.%20et%20al.Results%20of%20limb-sparing%20surgery%20with%20vascular%20replacement%20for%20soft%20tissue%20sarcoma%20in%20the%20lower%20extremity.J%20Vasc%20Surg.%202005%3B%2042%3A%2088-97Abstract%20Full%20Text%20Full%20Text%20PDF%20PubMed%20Scopus%20(82)%20Google%20Scholar%20However%2C%20many%20consider%20major%20blood%20vessel%20involvement%20to%20be%20a%20contraindication%20to%20attempts%20at%20total%20excision%20of%20retroperitoneal%20tumors%2C%20particularly%20if%20both%20aorta%20and%20inferior%20vena%20cava%20are%20involved.%20Schwarzbach%20et%20al%20described%20results%20in%2025%20patients%20requiring%20major%20blood%20vessel%20resection%20for%20retroperitoneal%20sarcomas.%203Schwarzbach%20M.H.M.%20Hormann%20Y.%20Hinz%20U.%20Leowardi%20C.%20B%C3%B6ckler%20D.%20Mechtersheimer%20G.%20et%20al.Clinical%20results%20of%20surgery%20for%20retroperitoneal%20sarcoma%20with%20major%20blood%20vessel%20involvement.J%20Vasc%20Surg.%202006%3B%2044%3A%2046-55Abstract%20Full%20Text%20Full%20Text%20PDF%20PubMed%20Scopus%20(131)%20Google%20Scholar%20Nine%20of%2010%20patients%20with%20negative%20resection%20margins%20survived%20at%20least%202%20years%20after%20resections%2C%20but%20it%20appears%20that%20only%20one%20of%20the%20entire%20group%20of%2025%20underwent%20replacement%20of%20both%20the%20aorta%20and%20inferior%20vena%20cava.%203Schwarzbach%20M.H.M.%20Hormann%20Y.%20Hinz%20U.%20Leowardi%20C.%20B%C3%B6ckler%20D.%20Mechtersheimer%20G.%20et%20al.Clinical%20results%20of%20surgery%20for%20retroperitoneal%20sarcoma%20with%20major%20blood%20vessel%20involvement.J%20Vasc%20Surg.%202006%3B%2044%3A%2046-55Abstract%20Full%20Text%20Full%20Text%20PDF%20PubMed%20Scopus%20(131)%20Google%20Scholar%20Our%20patient%20had%20isolated%20disease%20without%20evidence%20for%20pulmonary%20or%20other%20metastases.%20We%20offered%20surgery%20to%20the%20patient%20because%20long-term%20survival%20is%20possible%20with%20resection%20of%20isolated%20metastatic%20extraosseous%20osteosarcoma.%201Ahmad%20S.A.%20Patel%20S.R.%20Ballo%20M.T.%20Baker%20T.P.%20Yasko%20A.W.%20Wang%20X.%20et%20al.Extraosseous%20osteosarcoma%3A%20response%20to%20treatment%20and%20long-term%20outcome.J%20Clin%20Oncol.%202002%3B%2020%3A%20521-527Crossref%20PubMed%20Scopus%20(95)%20Google%20Scholar%20Both%20vascular%20grafts%20performed%20well%20until%20he%20died%20from%20metastatic%20disease.%20Anatomic%20situations%20requiring%20this%20extensive%20surgery%20are%20rare.%20However%2C%20highly%20selected%20patients%20may%20be%20candidates%20and%20may%20benefit%20from%20such%20surgery.%20Download%20.jpg%20(3.63%20MB)%20Help%20with%20jpg%20files%20Cover%20Image%22){kind=link}