Abstract
BACKGROUND: En bloc resection of adjacent structures, including major vessels, is often required to achieve negative margins in retroperitoneal sarcoma (RPS). However, the effect of vascular involvement and different reconstruction techniques in patients undergoing vascular resection remains unclear. This study investigated the morbidity, mortality, and long-term survival of patients who underwent an aggressive surgical approach with vascular resection for RPS. METHODS: We analyzed a prospectively maintained database of patients who underwent surgical resection (with or without vascular resection) for RPS between 2015 and 2020. The primary endpoint was long-term overall survival (OS). FINDINGS: The study population comprised 252 patients. Postoperative morbidity, mortality, and OS did not differ significantly between the vascular and no vascular resection groups. Among patients with vascular involvement, those who underwent aggressive surgical approach with vascular resection had a significantly higher OS (66.3 months vs. 25.6 months) compared to those who underwent palliative resection, without an increase in mortality or complication rate. No significant differences were observed in postoperative morbidity, 30-day mortality, or estimated median OS between patients who underwent primary repair and reconstruction. CONCLUSIONS: In patients with RPS with vascular involvement, an aggressive surgical approach with vascular resection achieved optimal clinical outcomes. Vascular reconstruction techniques had no impact on clinical outcomes.