November 04, 2009

Surgical Management of Tumors Involving the Aorta and Major Arterial Structures

Susanne G. Carpenter, MD¹, William B. Stone, MD¹, Thomas C. Bower, MD², Richard J. Fowl, MD¹, Samuel R. Money, MD¹.
¹Mayo Clinic Arizona, Phoenix, AZ, USA, ²Mayo Clinic Rochester, Rochester, MN, USA.

Objectives:
This study investigates surgical management of tumors arising from or involving the aorta and major arterial structures.
Methods:
A single institutional review of all patients undergoing arterial resection for tumors involving the aorta or major vascular structures from January 1992-May 2009 was performed. Patients with tumors abutting arteries without necessitating arterial resection and those involving only venous structures were excluded.
Results:
60 patients underwent arterial resection for the management of neoplasms. The iliac arteries were most commonly resected with sarcomatous pathology most commonly observed (39 patients, 65%).


Arterial Structure Involved	n (%) n = 60	Path margins free of tumor	Reconstruction	Mean Estimated Blood Loss (range)	30-day mortality
Aorta	12 (20%)	6/12 (50%)	9/12 (75%)	2.4L (0.76 - 6.5L)	2/12 (17%)
Carotid	6 (10%)	6/6 (100%)	4/6 (66%)	0.3L (0.05 - 0.7L)	0/6 (0%)
External/Common Iliac	16 (27%)	12/16 (75%)	11/16 (69%)	5.3L (0.3 - 25L)	0/16 (0%)
Internal Iliac	18 (30%)	15/18 (83%)	0/18 (0%)	3.6L (0.7 - 14L)	1/18 (6%)
Superficial Femoral	3 (5%)	2/3 (66%)	2/3 (66%)	0.88L (0.45-1.3L)	0/3 (0%)
Miscellaneous	5 (8%)	3/5 (60%)	4/5 (80%)	Data unavailable	0/5 (0%)

14 patients (23%) required return to the operating room. Mean follow-up was 16.6 months (range 0-122 months). 32 patients had greater than one year follow-up. Among those, 1-year overall survival was 69% with disease-free survival of 38%.
Conclusions:
Resection of tumors involving the aorta and major arterial structures provides a reasonable option for treatment, but with significant peri-operative morbidity. In selected patients, this aggressive surgical option should not be overlooked.

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