Abstract：
BACKGROUND: The role of en bloc vascular resection and reconstruction (EVRR) is controversial in colorectal adenocarcinoma (CRC), but well-established in retroperitoneal sarcoma (RPS). Sparse data exists regarding these complex procedures.
METHODS: Patients undergoing curative intent EVRR for advanced CRC and RPS between 2014 and 2021 at a tertiary centre were included. Morbidity, margins, recurrence, and survival were evaluated.
RESULTS: 24 patients underwent EVRR with 48 reconstructions (11 CRC and 13 RPS). For CRC, 100% of patients underwent Iliac system reconstructions. For RPS, inferior vena cava reconstructions were the most common (69.2%). There were 2 arterial and 1 venous graft thromboses. Primary graft patency was 89.4% arterial and 93.1% venous, while secondary patency was 100% arterial and 96.5% venous at last follow up. 1 venous and 1 arterial graft required reoperation for bleeding. There were no compromised limbs. Major complications occurred in 6 patients (25.0%) with no observed difference between CRC and RPS (OR 0.43 95%CI[0.60,3.19], P = 0.41). R1 margins occurred 1 CRC (90.9%) and 3 RPS (76.9%), with no R2 resections. All vascular resection margins were clear. There were 6 CRC (50%) and 4 RPS (33.3%) recurrences. Median recurrence time was 20.9 months for CRC and \'not yet reached\' for RPS. Median follow-up was 19.4 months for CRC and 21.4 months for RPS.
CONCLUSIONS: EVRR for locally advanced CRC or RPS is safe and achieves favorable R0 resection rates. CRC patients with major vascular invasion can still be considered for curative intent surgery. Larger cohorts with longer follow up are needed to assess oncologic outcomes.
METHODS: Patients undergoing curative intent EVRR for advanced CRC and RPS between 2014 and 2021 at a tertiary centre were included. Morbidity, margins, recurrence, and survival were evaluated.
RESULTS: 24 patients underwent EVRR with 48 reconstructions (11 CRC and 13 RPS). For CRC, 100% of patients underwent Iliac system reconstructions. For RPS, inferior vena cava reconstructions were the most common (69.2%). There were 2 arterial and 1 venous graft thromboses. Primary graft patency was 89.4% arterial and 93.1% venous, while secondary patency was 100% arterial and 96.5% venous at last follow up. 1 venous and 1 arterial graft required reoperation for bleeding. There were no compromised limbs. Major complications occurred in 6 patients (25.0%) with no observed difference between CRC and RPS (OR 0.43 95%CI[0.60,3.19], P = 0.41). R1 margins occurred 1 CRC (90.9%) and 3 RPS (76.9%), with no R2 resections. All vascular resection margins were clear. There were 6 CRC (50%) and 4 RPS (33.3%) recurrences. Median recurrence time was 20.9 months for CRC and \'not yet reached\' for RPS. Median follow-up was 19.4 months for CRC and 21.4 months for RPS.
CONCLUSIONS: EVRR for locally advanced CRC or RPS is safe and achieves favorable R0 resection rates. CRC patients with major vascular invasion can still be considered for curative intent surgery. Larger cohorts with longer follow up are needed to assess oncologic outcomes.
摘要：
背景：整块血管切除和重建（EVRR）在结直肠腺癌（CRC）中的作用存在争议，但在腹膜后肉瘤（RPS）中已确立。存在关于这些复杂过程的稀疏数据。
方法：纳入2014年至2021年在三级中心接受晚期CRC和RPS治疗的意向EVRR患者。发病率,边距,复发,和生存率进行了评估。
结果：24例患者接受了48例重建的EVRR（11例CRC和13例RPS）。对于CRC，100％的患者进行了Iliac系统重建。对于RPS，下腔静脉重建最常见(69.2%)。有2例动脉和1例静脉移植血栓形成。原发性移植物通畅率为89.4％动脉和93.1％静脉，而在最后一次随访时，继发性通畅率为100％动脉和96.5％静脉。1次静脉和1次动脉移植需要再次手术出血。没有四肢受损。6例患者（25.0%）发生严重并发症，CRC和RPS之间无差异（OR0.4395CI[0.60,3.19]，P=0.41）。R1裕度发生1个CRC（90.9%）和3个RPS（76.9%），没有R2切除。所有血管切缘清晰。有6例(50%)CRC和4例(33.3%)RPS复发。CRC的中位复发时间为20.9个月，RPS的中位复发时间为“尚未达到”。CRC的中位随访时间为19.4个月，RPS的中位随访时间为21.4个月。
结论：EVRR治疗局部晚期CRC或RPS是安全的，可获得良好的R0切除率。具有主要血管浸润的CRC患者仍可考虑进行根治性手术。需要更大的队列和更长的随访时间来评估肿瘤学结果。
方法：纳入2014年至2021年在三级中心接受晚期CRC和RPS治疗的意向EVRR患者。发病率,边距,复发,和生存率进行了评估。
结果：24例患者接受了48例重建的EVRR（11例CRC和13例RPS）。对于CRC，100％的患者进行了Iliac系统重建。对于RPS，下腔静脉重建最常见(69.2%)。有2例动脉和1例静脉移植血栓形成。原发性移植物通畅率为89.4％动脉和93.1％静脉，而在最后一次随访时，继发性通畅率为100％动脉和96.5％静脉。1次静脉和1次动脉移植需要再次手术出血。没有四肢受损。6例患者（25.0%）发生严重并发症，CRC和RPS之间无差异（OR0.4395CI[0.60,3.19]，P=0.41）。R1裕度发生1个CRC（90.9%）和3个RPS（76.9%），没有R2切除。所有血管切缘清晰。有6例(50%)CRC和4例(33.3%)RPS复发。CRC的中位复发时间为20.9个月，RPS的中位复发时间为“尚未达到”。CRC的中位随访时间为19.4个月，RPS的中位随访时间为21.4个月。
结论：EVRR治疗局部晚期CRC或RPS是安全的，可获得良好的R0切除率。具有主要血管浸润的CRC患者仍可考虑进行根治性手术。需要更大的队列和更长的随访时间来评估肿瘤学结果。
