The oncovascular surgeon in modern surgical oncology: A literature review

Involvement of major vascular structures by malignant tumors has historically been considered a contraindication to curative surgical resection. Advances in vascular reconstruction, perioperative management, and multimodal oncologic therapy have challenged this paradigm. Oncovascular surgery has emerged as a specialized field integrating radical oncologic resection with arterial and/or venous reconstruction, thereby expanding surgical resectability. Despite increasing evidence, the role of the oncovascular surgeon remains variably defined.

A narrative literature review was performed using PubMed/MEDLINE, Embase, and Scopus databases. Studies reporting oncologic resections involving major vascular ligation or reconstruction were included, focusing on soft tissue and retroperitoneal sarcomas, pancreatic cancer, hepatobiliary malignancies, pelvic and colorectal tumors, and renal cell carcinoma with caval involvement. Outcomes included perioperative morbidity and mortality, oncologic margins, survival, and contribution of the oncovascular surgeon.

Across multiple tumor types, en bloc resection with vascular reconstruction is feasible and can be performed with acceptable perioperative risk in selected patients. Oncologic outcomes are primarily driven by tumor biology and margin status rather than vascular reconstruction. Early involvement of the oncovascular surgeon improves planning and facilitates safe execution of complex resections. However, these procedures remain concentrated in high-volume centers and underutilized in routine practice.

Major vascular involvement should no longer be viewed as an absolute contraindication to curative cancer surgery. The oncovascular surgeon plays a pivotal role in redefining resectability and enabling margin-negative resections within a multidisciplinary framework. Broader integration of oncovascular expertise and structured training pathways is needed to improve outcomes in locally advanced malignancies.