Resection of retroperitoneal sarcoma en-bloc with inferior vena cava: 20 year outcomes of a single institution

Background: Margin negative resection offers the best chance of long-term survival in retroperitoneal sarcoma (RPS). En-bloc resection of adjacent structures, including the inferior vena cava (IVC), is often required to achieve negative margins. We review our 20-year experience of en-bloc IVC and RPS resection. Methods: Retrospective review of patients with RPS resection involving the IVC were matched 1:3 by age and histology to RPS without IVC resection. Prognostic factors for overall survival (OS) and disease free survival (DFS) were assessed. Results: Thirty-two patients underwent RPS resection en-bloc with IVC. They were matched with 96 cases of RPS without IVC resection. Median OS of 59 months and DFS 18 months in IVC resection group was comparable to RPS resection without vascular involvement: median OS 65 months, DFS 18 months (P=0.519, P=0.604). On multivariate analyses, R2 margin (OS: HR=6.52 [95%CI: 1.18-36.09], P=0.032) was associated with inferior OS. R2 margin and increased number of organs resected (DFS: HR=5.07, [1.15-22.27], P=0.031, HR=1.28 [1.01-1.62], P=0.014) were associated with inferior DFS. Reconstructions included graft (n=19, 59%), patch (n=4, 13%), primary repair (n=6, 19%), and ligation (n=4, 13%). Conclusions: RPS resection en-bloc with IVC can achieve equivalent rates of DFS and OS to patients without vascular involvement.