Pancreaticoduodenectomy and IVC resection in retroperitoneal sarcoma: Expanding the limits of feasible surgery

Combined resection of the pancreatic head/duodenum (PD) and inferior vena cava (IVC), along with other abdominal organs, is seldom performed in localized retroperitoneal sarcoma (RPS). However, the feasibility and safety of this approach may have implications for patient management.

All consecutive patients undergoing surgery for localized RPS at our Institution between January 2007 and December 2022 were reviewed. Primary endpoint was 90 days postoperative morbidity (Clavien-Dindo)/mortality. Secondary end-points were overall survival (OS) and disease-free survival (DFS).

Among 1138 patients treated with multivisceral resection (935 primary, 203 recurrent), 11/1138 (0.9 %) underwent concomitant PD and IVC resection (10/935 [1.0 %] primary, 1/203 [0.4 %] recurrent). Median age was 58 years (IQR 28-75). Histology included IVC leiomyosarcoma (n = 7), dedifferentiated liposarcoma (n = 3), and malignant peripheral nerve sheath tumour (n = 1). Median operative time was 614 min (IQR 480-932), with a median resected organ score of 5 (IQR 3.5-6.5). IVC reconstruction was performed in 8 patients (aortic homograft 4, IVC homograft 2, PTFE graft 1, PTFE patch 1). Major complications (Clavien-Dindo ≥ III) occurred in 46 %, including 3 re-operations and 1 post-operative death at 90 days. After a median follow-up of 38 months (IQR 9-150), 1- and 3-year OS were 78 % (95 % CI 55-100) and 52 % (95 % CI 27-100). Corresponding DFS rates were 48 % (95 % CI 22-100) and 16 % (95 % CI 3-94).

Concurrent PD and IVC resection in localized RPS is technically feasible but associated with high morbidity. Selected patients may achieve durable survival. Further validation through multicenter collaborative studies, including RESAR (NCT03838718), is warranted.