{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T21:30:21Z","timestamp":1774733421147,"version":"3.50.1"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,12,23]],"date-time":"2022-12-23T00:00:00Z","timestamp":1671753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Retroperitoneal sarcomas (RPSs) located in the lower abdominal quadrants involving iliac vessels are difficult to manage. This study introduced a 5-step method for en bloc resection with graft interposition using the abdominoinguinal approach and evaluated its efficacy and safety.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data of 24 consecutive patients who met the inclusion criteria from 272 patients with RPS who underwent surgical treatment between April 2015 and April 2022 were retrospectively collected and analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The patients underwent left- or right-sided abdominoinguinal incision. In all patients, the abdominoinguinal approach provided good exposure, and complete resection was achieved. Iliac artery+vein, vein, and artery resection and replacement by graft were performed in 70.8%, 25.0%, and 4.2% of patients, respectively. Additional resected organs mainly included the colon, ureter, bladder, kidney, and abdominal wall. The median number of organs resected was 5. In 37.5% of patients, reconstruction of the lower abdominal wall and inguinal ligament was performed using a mesh. Venous graft thrombosis occurred in 21.7% of patients, while no patient had pulmonary embolism or arterial occlusion. Major complications occurred in 20.8% of patients, and no 30-day mortality was observed. The estimated 5-year local recurrence and distant metastasis rates were 54.4% and 22.1%, respectively, with a median recurrence-free survival of 27 months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>En bloc resection of RPS involving iliac vessels with graft interposition using the abdominoinguinal approach is feasible and advantageous. Good complete resection rate and safety can be achieved. The long-term survival benefit of this surgical approach should be verified by further large-scale prospective controlled studies.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2022.1040833","type":"journal-article","created":{"date-parts":[[2022,12,23]],"date-time":"2022-12-23T06:30:38Z","timestamp":1671777038000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Abdominoinguinal approach in en bloc resection of retroperitoneal sarcoma involving iliac vessels with graft interposition"],"prefix":"10.3389","volume":"12","author":[{"given":"Ang","family":"Lv","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bo-Nan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dao-Ning","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhen","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun-Yi","family":"Hao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,12,23]]},"reference":[{"key":"B1","article-title":"Soft tissue and bone tumours","year":"2020","journal-title":"Lyon (France): Int Agency Res Cancer"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000001447","article-title":"Variability in patterns of recurrence after resection of primary retroperitoneal sarcoma (RPS): A report on 1007 patients from the multi-institutional collaborative RPS working group","volume":"263","author":"Gronchi","year":"2016","journal-title":"Ann Surg"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-014-4130-7","article-title":"Personalizing the approach to retroperitoneal soft tissue sarcoma: histology-specific patterns of failure and postrelapse outcome after primary extended resection","volume":"22","author":"Gronchi","year":"2015","journal-title":"Ann Surg Oncol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-021-09654-z","article-title":"Management of primary retroperitoneal sarcoma (RPS) in the adult: An updated consensus approach from the transatlantic Australasian RPS working group","volume":"28","author":"Swallow","year":"2021","journal-title":"Ann Surg Oncol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1002\/jso.27040","article-title":"Treatment algorithm and surgical outcome for primary and recurrent retroperitoneal sarcomas: A long-term single-center experience of 242 cases","volume":"126","author":"Lv","year":"2022","journal-title":"J Surg Oncol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-010-1057-5","article-title":"Aggressive surgery in retroperitoneal soft tissue sarcoma carried out at high-volume centers is safe and is associated with improved local control","volume":"17","author":"Bonvalot","year":"2010","journal-title":"Ann Surg Oncol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/s0960-7404(00)00028-1","article-title":"Abdominoinguinal incision and other incisions in the resection of pelvic tumors","volume":"9","author":"Karakousis","year":"2000","journal-title":"Surg Oncol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1002\/jso.21031","article-title":"The role of surgical margin status in retroperitoneal sarcoma","author":"Anaya","year":"2008","journal-title":"J Surg Oncol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1002\/ijc.2910330108","article-title":"Soft-tissue sarcomas of adults; study of pathological prognostic variables and definition of a histopathological grading system","volume":"33","author":"Trojani","year":"1984","journal-title":"Int J Cancer"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann Surg"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1982.01380300080018","article-title":"Exposure and reconstruction in the lower portions of the retroperitoneum and abdominal wall","volume":"117","author":"Karakousis","year":"1982","journal-title":"Arch Surg"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19841201)54:11<2543::aid-cncr2820541140>3.0.co;2-n","article-title":"The abdominoinguinal incision in limb salvage resection of pelvic tumors","volume":"54","author":"Karakousis","year":"1984","journal-title":"Cancer"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1002\/jso.2930260308","article-title":"Utility of the abdominoinguinal incision in the resection of lower abdominal tumors","volume":"26","author":"Karakousis","year":"1984","journal-title":"J Surg Oncol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000001455","article-title":"Sarcoma resection with and without vascular reconstruction: A matched case-control study","volume":"262","author":"Poultsides","year":"2015","journal-title":"Ann Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1016\/j.jvs.2006.03.001","article-title":"Clinical results of surgery for retroperitoneal sarcoma with major blood vessel involvement","volume":"44","author":"Schwarzbach","year":"2006","journal-title":"J Vasc Surg"},{"key":"B16","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1097\/SLA.0000000000001149","article-title":"Histology-based classification predicts pattern of recurrence and improves risk stratification in primary retroperitoneal sarcoma","volume":"263","author":"Tan","year":"2016","journal-title":"Ann Surg"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.2009.149","article-title":"Major blood vessel reconstruction during sarcoma surgery","volume":"144","author":"Song","year":"2009","journal-title":"Arch Surg"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1002\/jso.20945","article-title":"Results of limb-salvage surgery with vascular reconstruction for soft tissue sarcoma in the lower extremity: comparison between only arterial and arterovenous reconstruction","volume":"97","author":"Tsukushi","year":"2008","journal-title":"J Surg Oncol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.suronc.2016.05.002","article-title":"Vascular resection en-bloc with tumor removal and graft reconstruction is safe and effective in soft tissue sarcoma (STS) of the extremities and retroperitoneum","volume":"25","author":"Radaelli","year":"2016","journal-title":"Surg Oncol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.5582\/bst.2018.01015","article-title":"Infiltration characteristics and influencing factors of retroperitoneal liposarcoma: Novel evidence for extended surgery and a tumor grading system","volume":"12","author":"Wang","year":"2018","journal-title":"Biosci Trends"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.9829","article-title":"Long-term morbidity after multivisceral resection for retroperitoneal sarcoma","volume":"102","author":"Callegaro","year":"2015","journal-title":"Br J Surg"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-020-09307-7","article-title":"A prospective observational study of multivisceral resection for retroperitoneal sarcoma: clinical and patient-reported outcomes 1 year after surgery","volume":"28","author":"Fiore","year":"2021","journal-title":"Ann Surg Oncol"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2016.10.029","article-title":"Vascular reconstruction after retroperitoneal and lower extremity sarcoma resection","volume":"43","author":"Wortmann","year":"2017","journal-title":"Eur J Surg Oncol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/3056562","article-title":"The volume-outcome relationship in retroperitoneal soft tissue sarcoma: Evidence of improved short- and long-term outcomes at high-volume institutions","volume":"2018","author":"Bagaria","year":"2018","journal-title":"Sarcoma"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.31699","article-title":"Treatment at low-volume hospitals is associated with reduced short-term and long-term outcomes for patients with retroperitoneal sarcoma","volume":"124","author":"Keung","year":"2018","journal-title":"Cancer"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2022.1040833\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,23]],"date-time":"2022-12-23T06:30:40Z","timestamp":1671777040000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2022.1040833\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,23]]},"references-count":25,"alternative-id":["10.3389\/fonc.2022.1040833"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2022.1040833","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,23]]},"article-number":"1040833"}}