Cardiovascular interventions during oncologic surgery: technical principles and mid-term survival

Background: While the veins are primarly affected by compressing or invasiv e tumors, the arteries usually undergo only a less pronounced stenosis, due to the higher internal pressure. However some tumors infiltrate the arteri al adventitia which should be resected or might be injured in cases where r adical surgery is attempted. Patients and methods: We report some technical principles utilized in vario us vascular localizations and mid-term survival observed in a group of 35 p atients in whom a vascular reconstruction was performed during the surgical treatment of a malignant tumor: The following vessels were involved: carot id artery (n=5), superior vena cava (n=9), aortic arch (n=1), subclavian ar tery (n=1), right atrium +/- inferior vena cava (n=6), abdominal aorta (n=3 ) and finally iliac artery and/or vein (n=10). The following surgical techniques were employed: extra-anatomic bypass (n=3 ), in situ reconstruction (n=23) using either prosthetic graft or saphenous vein interposition patch angioplasty with autologous vein or xenopericardi um and ligature of the involved artery or vein (n=4). In 5 patients sufferi ng from hypernephroma with a tumor thrombus, cardiopulmonary bypass was use d to allow radical intracardiac excision. Results: There was no intraoperative mortality despite the fact that a majo rity of these vascular procedures was performed after incidental and unexpe cted finding during surgery. Two patients died before hospital discharge (o ne from pneumonia, the second one from sepsis). Mid-term survival was satis factory with 45% of the patients still alive after a mean follow-up of 4.5 years - all tumor types confounded. Conclusions: This series demonstrates that an aggressive approach might be justified in appropriate patients who otherwise might not be considered as operative candidates.