533. External Hemipelvectomy Experience at National Cancer Institute in Mexico

S 885 532. Multifocal Retroperitoneal Sarcoma Report of an Unusual Case D. Voros, T. Theodosopoulos, V. Psychogiou, A. Yiallourou, A. Karakatsanis, E. Karvouni, G. Polymeneas 1 Athens University Hospital, 2nd Surgical Department, Athens, Greece Athens University Hospital, Pathology Department, Athens, Greece Background: There are studies in recent years about the multifocality of retroperitoneal sarcomas. That compromises the management and the prognosis of them. We have published in the past a series of 29 pts with RPS, 7 of whom (24%) being with multifocal disease at the time of the diagnosis, whereas more recent data includes 13/64 (20,3%) respectively. Material and methods: We present a case of a 64 years old male who present with four different foci at the time of diagnosis. He complaint of non typical mild discomfort and swelling of the left inguinal area. He underwent a CT scan which revealed: a) left iliac fossa mass 11x10,5x9cm, b) left inguinal mass 6x5,5x2,5cm, c) right iliac fossa mass 4,3cm and d) a 2,5x2x2 mass in the mediastinum. The patient 6 months prior to his admission had a stent placement for coronary disease and he was under anticoagulants agents. Results: The patient in a district hospital because of his comorbidity underwent excision of the left inguinal mass, which appeared to be liposarcoma. He was referred to our hospital and had a midline laparotomy with concominant radical excision of the other two masses of the left and right iliac fossa, which were liposarcomas as well. The left iliac fossa mass had a separate satellite 4 cm stalk. Conclusions: The multifocality of the RPS are of great significance because a) need carefull planning of the radical operation from the beginning and b) makes the prognosis worse. 533. External Hemipelvectomy Experience at National Cancer Institute in Mexico A.E. Padilla Rosciano, C.D. Lever Rosas, M.G. Serna Thome, L.M. Dominguez Parra, H. Martinez Said, M. Cuellar Hubbe, I. Vela Sarmiento, A. Herrera Gomez 1 National Cancer Institute Mexico, Soft Tissue and Bone Sarcomas, Naucalpan Edo de Mexico., Mexico National Cancer Institute Mexico, Clinical Nutrition and Surgical Oncology, Naucalpan Edo de Mexico., Mexico Hospital alta especialidad., Surgical Oncology, Merida Yucatan, Mexico National Cancer Institute Mexico, Soft Tissue and Bone Sarcomas, Naucalpan Edo de Mexico, Mexico Background: Despite the development of successful therapeutic modalities for local sarcomas control and advances in limb sparing surgery around the pelvis and hip, the external hemipelvectomy often remains the optimal surgery treatment in primary tumor or recurrences of the upper thigh, hip and pelvis. Material and methods: Retrospective review of 78 external hemipelvectomies performed at National Cancer Institute Mexico, during the period 1978-2005 mainly for bone and soft tissue sarcomas. Overall survival was calculated using the method of Kaplan and Meier and differences were calculated using the log rank test. Results: There were 78 patients, 49 males and 29 females. The mean age was 36 years (range 16-80 years), the classic hemipelvectomy was performed in 61 (86%) and amplified hemipelvectomy in ten cases (14%) the most frequent tumors were osteosarcoma 12 patients, synovial sarcoma and chondrosarcoma 11 patients respectively. The posterior flap was performed in 61 and anterior flap in ten cases, 6 patients died within 30 days of surgical procedure because hipovolemic shock, sepsis and cardiac failure, one patient die 51 days after hemipelvectomy. These seven cases were not entered in analysis for complications and survival. The mean tumor size was 18 cms, the mean blood loss was 1677 ml (range 0.25-8 L) and mean duration of procedure was 3.93 hours (2.10-9.45 hours), negative margin was obtained in 55 of 71, postoperative complications occurred in 43 patients (60.5%), including wound infection 44%, dehiscence 22% and partial flap necrosis 11.5%, with severe complications in 18.3%, 36 patients had local complications and other complications in 18, some patients had both wound and other complications. When compared classic vs amplified hemipelvectomy the mean blood loss was 1,436 ml vs 3,120 ml respectively (p1⁄40.0001) and mean surgical time 3.7 vs 5.3 hours (p1⁄40006). The factors associated to complications were surgical time more than 4 hours (p1⁄40.044), surgical bleeding more than 1.5 L (p1⁄40.316) and in multivariate analysis Hb less of 12 grs before hemipelvectomy (p1⁄40.05), surgical bleeding (p1⁄40.05), surgical time (p1⁄40.07).The surgical mortality was 8.9%, fifty percent were dead at 7.5 months with positive surgical margins and 7 months with negative margins. In bone sarcomas 50% were dead at 9 months and 6.2 months for soft tissue sarcomas, median survival in synchronous metastasis was 6.2 months and 9.5 months in patients without metastasis, however 5 years survival was 12%. Conclusions: The external hemipelvectomy is a rare procedure with considerable morbidity, mortality and poor survival results. Must be considered as a palliative procedure even without metastatic disease, the quality of life must be careful considered before to offer an external hemipelvectomy, however this procedure offers a chance of palliation and a little chance of cure 534. A Rare Case of Inferior Vena Cava Leiomyosarcoma A. Samaiya, V. Kanhere, R. Singhal, R. Jain 1 Jawaharlal Nehru Cancer Hospital & Research Center, Surgical Oncology, Bhopal, India 2 Chirayu Cardiac Centre, Ctvs Surgeon, Bhopal, India 3 Jawaharlal Nehru Cancer Hospital And Research Centre, Pathology, Bhopal, India Introduction: Primary intraluminal leiomyosarcoma of the inferior vena cava (IVC) is an extremely rare tumour with variable behaviour patterns. We report one such case. Case report: A: 69/M presented with heaviness and pain in right lumbar region. On examination, found an ill defined right hypochondrium and lumbar mass. CT scan was suggestive of right retroperitoneal tumour involving the infrarenal inferior vena cava (IVC). Patient planned for exploratory laparotomy. ON exploration, tumour was arising from IVC. Excision of IVC with ligation of both ends done. Histopathology and IHC showed low grade intraluminal leiomyosarcoma. After 1 year of follow up, patient developed lungs, liver and subcutaneous metastases without any evidence of loco regional recurrence. Patient was asymptomatic and refused any chemotherapy. Patient is still asymptomatic and maintaining good health even one year after the diagnoses of metastases. Conclusion: Intraluminal IVC leiomyosarcoma in old age male is very rare. The behaviour pattern of tumour is unusual. It will be interesting to see the further behaviour of tumour in this patient. 535. Gastrointestinal Stromal Tumour Diagnosis and Therapy S. Gluszek, R. Rylski, J. Matykiewicz, D. Koziol, P. Lewitowicz 1 Regional Hospital, Genaral Oncological and Endocrine Surgery, Kielce, Poland 2 Regional Hospital Faculty of Health Sciences Jan Kochanowski University in Kielce, Genaral Oncological and Endocrine Surgery, Kielce, Poland 3 Faculty of Health Sciences Jan Kochanowski University in Kielce, Kielce, Poland Background: Gastrointestinal stromal tumour (GIST) is the most common mesenchymal tumour of digestive tract, comprising less than 1% of all digestive tumours. Stomach (60%) and small intestine (30%) are the commonest locations for GIST. The aim of this study is an analysis of group of patients treated surgically due to GIST. This analysis was undertaken to identify principles for diagnosis, treatment and prognostic evaluation (recurrence, dissemination) are fundamental assessment criteria. Material and methods: A group of 68 patients comprised of 33 males (M) and 36 females(F) between 32 and 89 of age (M 44-83; F 43-89)