基于倾向性评分匹配的联合血管切除治疗腹膜后脂肪肉瘤临床疗效分析OA

Objective To evaluate the safety,oncological efficacy,and long term survival impact of concomitant vascular resection(VR)in the surgical treatment of retroperitoneal liposarcoma(RPLS).Methods Clinical and pathological data of 622 patients with retroperitoneal liposarcoma(RPLS)treated at the Department of Retroperitoneal and Soft Tissue Tumor Surgery,Zhongshan Hospital,Fudan University,between January 2010 and December 2023 were retrospectively analyzed.All the patients were enrolled in the study and divided into a non vascular resection group(non VR,n=533)and a vascular resection group(VR,n=89)based on whether concomitant VR was performed intraoperatively.Propensity score matching(PSM)at a 1∶1 ratio was applied,yielding 89 patients in each group.Clinical data was compared between the two groups.Results After PSM,the VR group exhibited significantly greater intraoperative blood loss,allogeneic blood transfusion volume,operative time,intensive care unit(ICU)length of stay,total hospital stay,and incidence of postoperative vascular related complications compared with the non VR group(P＜0.05).No statistically significant differences were observed between the two groups in 30 day postoperative mortality or the proportion of patients with Clavien-Dindo grade ≥ Ⅲcomplications(P＞0.05).Multivariate Cox regression analysis identified R2 surgical margin as an independent risk factor for overall survival(OS)(R2 vs.R0/R1:HR=4.436,95％CI 2.223-8.850,P＜0.001).FNCLCC grade Ⅱ and Ⅲ were independent risk factors for both OS(grade Ⅱ vs.grade Ⅰ:HR=3.543,95％CI 1.322-9.492,P=0.012;grade Ⅲ vs.grade Ⅰ:HR=5.015,95％CI 1.794-14.021,P=0.002)and recurrence free survival(RFS)(grade Ⅱ vs.grade Ⅰ:HR=2.345,95％CI 1.212-4.536,P=0.011;grade Ⅲ vs.grade Ⅰ:HR=3.785,95％CI 1.817-7.885,P=0.002).The median OS in the non VR and VR groups was 60 months and 63.8 months,respectively;the median RFS was 20 months and 25.2 months,respectively.No statistically significant differences were found between the two groups in OS or RFS(OS:HR=0.96,95％CI 0.61-1.52,P=0.872;RFS:HR=0.96,95％CI 0.67-1.39,P=0.835).Conclusion Although concomitant VR is associated with increased surgical trauma and a higher risk of vascular related complications,it does not result in elevated rates of severe postoperative complications or 30 day mortality.Although VR itself is not an independent prognostic factor,it provides an opportunity for R0/R1 resection in locally advanced RPLS involving major vessels.