Resection of the inferior vena cava (IVC) for malignancy is a technically demanding procedure. We present a series of six cases of resection of the IVC for retroperitoneal sarcomas, four of which were primary caval tumors. We outline the technical difficulties faced in these complex procedures and discuss the oncological outcomes of these rare tumors. We performed a retrospective review of six patients operated for retroperitoneal masses involving the inferior vena cava between April 2015 and July 2016 at our tertiary care institute. Six patients underwent resection of the IVC, three of which required a multivisceral resection. An artificial prosthesis was used to reconstruct the IVC in three patients, whereas two patients underwent primary repair of the vein wall. One patient did not require any reconstruction. Margins were microscopically positive in two out of six patients. All patients received radiotherapy, either in the neo-adjuvant or adjuvant setting. Two patients developed local recurrences with a median follow-up of 24.5 months. Resection of the IVC for extirpation of retroperitoneal sarcomas is a technically complex and difficult procedure. The availability of a multidisciplinary team of surgeons and state-of-the-art intensive care support is essential for good outcomes.
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Conflict of Interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. As this is a retrospective study, for this type of study, formal consent is not required. However, informed consent was obtained from all individual participants included in the study.
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Consent has been obtained from the patients/guardians for publication of relevant medical data and operative photographs without revelation of patient identity in this study.
Dzsinich C, Gloviczki P, van Heerden JA et al (1992) Primary venous leiomyosarcoma: a rare but lethal disease. J Vasc Surg 15:595–603CrossRefGoogle Scholar
Quinones-Baldrich W, Alktaifi A, Eilber F, Eilber F (2012) Inferior vena cava resection and reconstruction for retroperitoneal tumor excision. J Vasc Surg 55(5):1386–1393CrossRefGoogle Scholar
Daylami R, Amiri A, Goldsmith B et al (2010) Inferior vena cava leiomyosarcoma: is reconstruction necessary after resection? J Am Coll Surg 210:185–190CrossRefGoogle Scholar
Kieffer E, Alaoui M, Piette JC et al (2006) Leiomyosarcoma of the inferior vena cava: experience in 22 cases. Ann Surg 244:289–295CrossRefGoogle Scholar
Mastoraki A, Leotsakos G, Mastoraki S et al (2015) Challenging diagnostic and therapeutic modalities for leiomyosarcoma of inferior vena cava. Int J Surg 13:92–95CrossRefGoogle Scholar
Kraybill WG, Callery MP, Heiken JP, Flye MW (1997) Radical resection of tumors of the inferior vena cava with vascular reconstruction and kidney autotransplantation. Surgery 121:31–36CrossRefGoogle Scholar
Hardwigsen J, Baqué P, Crespy B et al (2001) Resection of the inferior vena cava for neoplasms with or without prosthetic replacement: a 14-patient series. Ann Surg 233(2):242–249CrossRefGoogle Scholar
Stauffer JA, Fakhre GP, Dougherty MK et al (2009) Pancreatic and multiorgan resection with inferior vena cava reconstruction for retroperitoneal leiomyosarcoma. World J Surg Oncol 7:3CrossRefGoogle Scholar
Bower TC, Nagorney DM, Cherry KJ Jr et al (2000) Replacement of the inferior vena cava for malignancy: an update. J Vasc Surg 31:270–281CrossRefGoogle Scholar
Chin PT, Gallagher PJ, Stephen MS (1999) Inferior vena caval resection with autogenous peritoneo-fascial patch graft caval repair: a new technique. Aust N Z J Surg 69:391–392CrossRefGoogle Scholar
Glovicski P, Hollier LH, Dewanjee MK et al (1984) Experimental replacement of the inferior vena cava: factors affecting patency. Surgery 95:657–666Google Scholar
Hollenbeck ST, Grobmyer SR, Kent KC et al (2003) Surgical treatment and outcomes of patients with primary inferior vena cava leiomyosarcoma. J Am Coll Surg 197:575–579CrossRefGoogle Scholar
Guerrero MA, Cross CA, Lin PH et al (2007 Jul) Inferior vena cava reconstruction using fresh inferior vena cava allograft following caval resection for leiomyosarcoma: midterm results. J Vasc Surg 46(1):140–143CrossRefGoogle Scholar
Pulitanó C, Crawford M, Ho P et al (2013) The use of biological grafts for reconstruction of the inferior vena cava is a safe and valid alternative: results in 32 patients in a single institution. HPB 15(8):628–632CrossRefGoogle Scholar
Hines OJ, Nelson S, Quinones-Baldrich WJ et al (1999) Leiomyosarcoma of the inferior vena cava: prognosis and comparison with leiomyosarcoma of other anatomic sites. Cancer 85:1077–1083CrossRefGoogle Scholar
Mann GN, Mann LV, Levine EA, Shen P (2012 Feb) Primary leiomyosarcoma of the inferior vena cava: a 2-institution analysis of outcomes. Surgery 151(2):261–267CrossRefGoogle Scholar
Sarkar R, Eilber FR, Gelabert HA, Quinones-Baldrich WJ (1998) Prosthetic replacement of the inferior vena cava for malignancy. J Vasc Surg 28(1):75–83CrossRefGoogle Scholar
Mingoli A, Cavallaro A, Sapienza P et al (1996) International registry of inferior vena cava leiomyosarcoma: analysis of a world series on 218 patients. Anticancer Res 16:3201–3205PubMedGoogle Scholar
Ito H, Hornick JL, Bertagnolli MM et al (2007) Leiomyosarcoma of the inferior vena cava: survival after aggressive management. Ann Surg Oncol 14(12):3534–3541CrossRefGoogle Scholar
Singer S, Corson JM, Demetri GD et al (1995) Prognostic factors predictive of survival for truncal and retroperitoneal soft-tissue sarcoma. Ann Surg 221(2):185–195CrossRefGoogle Scholar
Wachtel H, Jackson BM, Bartlett EK et al (2015 Mar) Resection of primary leiomyosarcoma of the inferior vena cava (IVC) with reconstruction: a case series and review of the literature. J Surg Oncol 111(3):328–333CrossRefGoogle Scholar
Trans-Atlantic RPS Working Group (2015) Management of primary retroperitoneal sarcoma (RPS) in the adult: a consensus approach from the Trans-Atlantic RPS Working Group. Ann Surg Oncol 22(1):256–263CrossRefGoogle Scholar
Kelly KJ, Yoon SS, Kuk D et al (2015) Comparison of perioperative radiation therapy and surgery versus surgery alone in 204 patients with primary retroperitoneal sarcoma: a retrospective two-institution study. Ann Surg 262(1):156–162CrossRefGoogle Scholar
Trovik C, Bauer HCF, Styring E et al (2017) The Scandinavian Sarcoma Group Central Register: 6,000 patients after 25 years of monitoring of referral and treatment of extremity and trunk wall soft-tissue sarcoma. Acta Orthop 88(3):341–347CrossRefGoogle Scholar
Nussbaum DP, Rushing CN, Lane WO et al (2016) Preoperative or postoperative radiotherapy versus surgery alone for retroperitoneal sarcoma: a case-control, propensity score-matched analysis of a nationwide clinical oncology database. Lancet Oncol 17(7):966–975CrossRefGoogle Scholar
Baldini EH, Wang D, Haas RL et al (2015) Treatment guidelines for preoperative radiation therapy for retroperitoneal sarcoma: preliminary consensus of an international expert panel. Int J Radiat Oncol Biol Phys 92(3):602–612CrossRefGoogle Scholar
Kim JT, Kwon T, Cho Y et al (2012 Feb) Multidisciplinary treatment and long-term outcomes in six patients with leiomyosarcoma of the inferior vena cava. J Korean Surg Soc 82(2):101–109CrossRefGoogle Scholar
Miura JT, Charlson J, Gamblin TC et al (2015) Impact of chemotherapy on survival in surgically resected retroperitoneal sarcoma. Eur J Surg Oncol 41(10):1386–1392CrossRefGoogle Scholar