Improved Perioperative Outcomes with Staged Arterial Bypass Preceding Resection of Retroperitoneal Masses Involving Major Vessels

Objective: To characterize and compare the outcomes of surgery for retroperitoneal masses with major vascular involvement by a novel two-stage approach (femoral-femoral bypass preceding resection) and the traditional one-stage... [ view full abstract ]

Objective: To characterize and compare the outcomes of surgery for retroperitoneal masses with major vascular involvement by a novel two-stage approach (femoral-femoral bypass preceding resection) and the traditional one-stage approach (resection followed by in-situ vascular reconstruction).
Background: Current surgical management of retroperitoneal masses involving major vessels now includes complete en-bloc resection with in-situ venous, arterial, or combined reconstruction. Bleeding complications and lengthy operations are frequently associated with perioperative morbidity. No studies have investigated pre-resection arterial bypass for continuous lower extremity perfusion during definitive resection. 
Methods: We retrospectively reviewed patients who underwent resection of retroperitoneal masses and reconstruction of major arterial or venous structures from 2004 to 2016. Demographics, clinicopathologic data, complications, and vascular and oncologic outcomes were analyzed with unpaired t-tests, chi-squared tests, and logistic regression.
Results: Eight patients underwent a two-stage procedure and seven underwent a one-stage procedure for retroperitoneal masses with vascular involvement. Mean (±SD) operating room time (443±215 vs. 648±128 min., p=0.047) and post-operative ICU stay (0.9±1.3 vs. 4.4±2.9 days, p=0.018) were shorter for the two-stage approach. Estimated blood loss (2,287±1,808 vs. 8,928±10,066 mL, p=0.13) and transfusion volumes (2,362±2,353 vs. 7,728±9,223 mL, p=0.13) were not significantly reduced in the two-stage technique, likely because of lack of power.
Conclusions: To our knowledge, this is the first report of a two-stage approach for resection of retroperitoneal masses with major vessel involvement. Femoral-femoral arterial bypass before definitive resection may be a viable option for improving intraoperative vascular control and decreasing perioperative complications in these complex procedures.