Introduction/Background Major vascular resection in patients with gynecologic malignancy is rarely performed; however, sometimes, it is necessary to achieve complete cytoreduction. The literature is limited, and we would like to report our results on patients undergoing primary debulking surgery with major vascular resection.
Methodology We aimed to observe the outcome of patients undergoing vascular resection to obtain optimal cytoreduction. Consultant surgeons from our Vascular Surgery Department were present during the procedures. We analyzed the oncologic outcome and the complications to evaluate the feasibility and safety of the procedure.
Results From September 2020 to February 2022, a total of three patients with aggressive pelvic tumors underwent cytoreductive surgery. The first and third patients were diagnosed with high-grade serous ovarian cancer, whereas the second suffered from stromal proliferation. The left external iliac vein resection was performed in the first patient, with no reconstruction needed due to the presence of collaterals. In patient 2, partial resection and reconstruction of the left external iliac artery was performed. The infrarenal inferior vena cava was resected in patient 3. Low-molecular-weight heparin and anti-embolism stockings were administered as thromboprophylaxis. In all three patients, intra/post-operative transfusions of blood components were needed. Vascular postoperative complications were edema of the left inferior limb(patient 1); and compartment syndrome with initial neurologic damage(patient 2), requiring thrombectomy and stenting of the left common iliac, deep and superficial femoral artery, and medial and lateral left lower limb fasciotomy. Both patients with ovarian cancers received adjuvant chemotherapy. Follow-up visits and total body CT scans at 3 and 6 months were negative for recurrence.
Conclusion Surgical management of tumors involving vascular structures can lead to extended and challenging procedures. From our small case series, we believe that in case of tumor infiltrating major vessels, complete resection is feasible and should be performed to achieve optimal cytoreduction.
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