Society of Asian Academic Surgeons Outcomes of arterial bypass preceding resection of retroperitoneal masses involving major vessels Hubert Y. Luu, MD, MS, a Eric D. Wang, MD, b Shareef M. Syed, MD, a Xiaoti Xu, MD, b Scott L. Hansen, MD, b Charles M. Eichler, MD, c and Eric K. Nakakura, MD, PhD d, * a Department of Surgery, University of California San Francisco, San Francisco, California b Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, California c Division of Vascular and Endovascular Surgery, University of California San Francisco, San Francisco, California d Division of General Surgery, Section of Gastrointestinal Surgical Oncology/Hepatopancreatobiliary Surgery, University of California San Francisco, San Francisco, California article info Article history: Received 2 January 2018 Received in revised form 4 April 2018 Accepted 17 April 2018 Available online xxx Keywords: Retroperitoneal sarcoma Sarcoma Femoral bypass Oncovascular surgery Surgical oncology abstract Background: Current surgical management of retroperitoneal masses involving major ves- sels now includes complete en bloc resection with in situ venous, arterial, or combined reconstruction. No studies have investigated preresection arterial bypass for continuous lower extremity perfusion during definitive resection. Here, we characterize and compare the outcomes of surgery for retroperitoneal masses with major vascular involvement by a two-stage approach (femoral-femoral bypass preceding resection) and the traditional one- stage approach (consecutive resection and in situ vascular reconstruction). Materials and methods: We retrospectively reviewed patients who underwent resection of retroperitoneal masses and reconstruction of major arterial or venous structures from 2004 to 2016. Outcomes were compared with unpaired t-tests, chi-squared tests, and KaplaneMeier analysis. Results: Eight patients underwent a two-stage procedure, and seven underwent a one-stage procedure for retroperitoneal masses with vascular involvement. Mean (SD) oncologic resection time (443  215 versus 648  128 min, P ¼ 0.047) and postoperative ICU stay (0.9  1.3 versus 4.4  2.9 d, P ¼ 0.018) were significantly shorter for the two-stage approach. Conclusions: To our knowledge, this is the first report of a two-stage approach for resection of retroperitoneal masses with major vessel involvement. Femoral-femoral arterial bypass before definitive resection could be a viable option for improving intraoperative vascular control and decreasing perioperative complications in these complex procedures. Published by Elsevier Inc. * Corresponding author. Department of General Surgery, Section of Gastrointestinal Surgical Oncology/Hepatopancreatobiliary Surgery, University of California San Francisco, Box 1932, San Francisco, CA 94143. Tel.: þ1 415 353-9294; fax: þ1 415 353-9695. E-mail address: eric.nakakura@ucsf.edu (E.K. Nakakura). Available online at www.sciencedirect.com ScienceDirect journal homepage: www.JournalofSurgicalResearch.com journal of surgical research  october 2018 (230) 34 e39 0022-4804/$ e see front matter Published by Elsevier Inc. https://doi.org/10.1016/j.jss.2018.04.039