Skip to main content

Advertisement

SpringerLink
Log in

Inferior Vena Cava Leiomyosarcoma: What Method of Reconstruction for Which Type of Resection?

  • Scientific Review
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Inferior vena cava leiomyosarcoma (IVCL) is a rare tumor with a poor prognosis, and its surgical resection remains a challenge. To date, surgery is the only potentially curative treatment for IVCL with a 5-year survival rate of 55%. The main challenge is to combine oncological surgery with clear margins and vascular reconstruction of the inferior vena cava (IVC). In this review, we discuss the different approaches to vascular reconstruction after IVCL resection, using a prosthetic or autologous patch, direct suture or simple ligation without IVC reconstruction. The reconstruction of IVC depends of tumor location and its extension. We recommend no reconstruction if venous collaterality is well-established. When vascular reconstruction is required, we prefer prosthetic PTFE graft. These patients should be referred to high-volume centers with a multidisciplinary team of sarcoma surgeons with cardiothoracic, vascular and hepatic specialties.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

LMS:

Leiomyosarcoma

STS:

Soft tissue sarcoma

IVC:

Inferior vena cava

IVCL:

Inferior vena cava leiomyosarcoma

ESMO:

European Society of Medical Oncology

MRI:

Magnetic resonance imaging

CT scan:

Computed tomography scan

RPS:

Retroperitoneal sarcoma

FNCLCC:

Fédération Nationale des Centres de Lutte Contre le Cancer

RA:

Right atrium

PTFE:

Polytetrafluoroethylene

References

  1. Penel N, Coindre J-M, Toulmonde M, Blay J-Y (2017) Presentation and outcome of frequent and rare sarcoma histologic subtypes: a study of 10,262 patients with localized visceral/soft tissue sarcoma managed in reference centers. Cancer 124(6):1179–1187

    Article  PubMed  Google Scholar 

  2. Alkhalili E, Greenbaum A, Langsfeld M, Marek J, Rana MA, Glew R et al (2016) Leiomyosarcoma of the inferior vena cava: a case series and review of the literature. Ann Vasc Surg 33:245–251

    Article  PubMed  Google Scholar 

  3. Gohrbandt AE, Hansen T, Ell C, Heinrich SS, Lang H (2016) Portal vein leiomyosarcoma: a case report and review of the literature. BMC Surg 16(1):60

    Article  PubMed  PubMed Central  Google Scholar 

  4. Boudjema K, Sulpice L, Levi Sandri GB, Meunier B (2014) Portal vein leiomyosarcoma, an unusual cause of jaundice. Dig Liver Dis 46(11):1053–1054

    Article  PubMed  Google Scholar 

  5. Novak M, Perhavec A, Maturen KE, Pavlovic Djokic S, Jereb S, Erzen D (2017) Leiomyosarcoma of the renal vein: analysis of outcome and prognostic factors in the world case series of 67 patients. Radiol Oncol 51(1):56–64

    Article  PubMed  Google Scholar 

  6. Wu W, Zhao X, Wang Y, Di C, Cai R, Zhang Y et al (2017) Leiomyosarcoma of the splenic vein: a case report. Oncol Lett 14(1):977–980

    Article  PubMed  PubMed Central  Google Scholar 

  7. Cimino M, Mussi C, Colombo P, Lutman F, Quagliuolo V (2013) Leiomyosarcoma arising from the inferior mesenteric vein draining in the splenomesenteric angle with a tumour thrombus at the splenomesenteric confluence: a case report and review of the literature. Updat Surg 65(4):313–316

    Article  CAS  Google Scholar 

  8. Casali PG, Abecassis N, Bauer S, Biagini R, Bielack S, Bonvalot S et al (2018) Soft tissue and visceral sarcomas: ESMO-EURACAN clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol Off J Eur Soc Med Oncol 29(Supplemen_4):iv51–iv67

    Article  CAS  Google Scholar 

  9. Kennedy SA, Milovanovic L, Midia M (2015) Major bleeding after percutaneous image-guided biopsies: frequency, predictors, and periprocedural management. Semin Interv Radiol 32(1):26–33

    Article  Google Scholar 

  10. Balaney B, Mitzman B, Fung J, Paul JD (2018) Diagnosis and management of rare inferior vena cava leiomyosarcoma guided by a novel minimally invasive vascular biopsy technique. Catheter Cardiovasc Interv 92(4):752–756

    Article  PubMed  Google Scholar 

  11. Kraft S, Fletcher CDM (2011) Atypical intradermal smooth muscle neoplasms: clinicopathologic analysis of 84 cases and a reappraisal of cutaneous “leiomyosarcoma”. Am J Surg Pathol 35(4):599–607

    Article  PubMed  Google Scholar 

  12. Wachtel H, Gupta M, Bartlett EK, Jackson BM, Kelz RR, Karakousis GC et al (2015) Outcomes after resection of leiomyosarcomas of the inferior vena cava: a pooled data analysis of 377 cases. Surg Oncol 24(1):21–27

    Article  PubMed  Google Scholar 

  13. Roland CL, Boland GM, Demicco EG, Lusby K, Ingram D, May CD et al (2016) Clinical observations and molecular variables of primary vascular leiomyosarcoma. JAMA Surg 151(4):347–354

    Article  PubMed  PubMed Central  Google Scholar 

  14. Bonvalot S, Raut CP, Pollock RE, Stoeckle E, Hohenberger P, Gronchi A (2012) Technical considerations in surgery for retroperitoneal sarcomas: position paper from E-Surge, a master class in sarcoma surgery, and EORTC-STBSG. Ann Surg Oncol 19(9):2981–2991

    Article  PubMed  Google Scholar 

  15. Mastoraki A, Leotsakos G, Mastoraki S, Papanikolaou IS, Danias N, Smyrniotis V et al (2015) Challenging diagnostic and therapeutic modalities for leiomyosarcoma of inferior vena cava. Int J Surg Lond Engl 13:92–95

    Article  Google Scholar 

  16. Hollenbeck ST, Grobmyer SR, Kent KC, Brennan MF (2003) Surgical treatment and outcomes of patients with primary inferior vena cava leiomyosarcoma. J Am Coll Surg 197(4):575–579

    Article  PubMed  Google Scholar 

  17. Tzanis D, Bouhadiba T, Gaignard E, Bonvalot S (2018) Major vascular resections in retroperitoneal sarcoma. J Surg Oncol 117(1):42–47

    Article  PubMed  Google Scholar 

  18. Fiore M, Colombo C, Locati P, Berselli M, Radaelli S, Morosi C et al (2012) Surgical technique, morbidity, and outcome of primary retroperitoneal sarcoma involving inferior vena cava. Ann Surg Oncol 19(2):511–518

    Article  PubMed  Google Scholar 

  19. Jiang H, Wang Y-X, Li B, Jiang Y-Y, Miao C-L, Liao D-X et al (2015) Surgical management of leiomyosarcoma of the inferior vena cava. Vascular 23(3):329–332

    Article  PubMed  Google Scholar 

  20. Bednarova I, Frellesen C, Roman A, Vogl TJ (2018) Case 257: leiomyosarcoma of the inferior vena cava. Radiology 288(3):901–908

    Article  PubMed  Google Scholar 

  21. Cinà CS, Riccioli V, Passanisi G, Musumeci G, Loreto C, Castorina S (2013) Computerized tomography and 3-D rendering help to select surgical strategy in leiomyosarcoma of the inferior vena cava. Updat Surg 65(4):283–288

    Article  Google Scholar 

  22. Liu D, Ren H-L, Liu B, Shao J, Chen Y-X, Song X-J et al (2018) Renal function preservation in surgical resection of primary inferior vena cava leiomyosarcoma involving the renal veins. Eur J Vasc Endovasc Surg 55(2):229–239

    Article  PubMed  Google Scholar 

  23. Mann GN, Mann LV, Levine EA, Shen P (2012) Primary leiomyosarcoma of the inferior vena cava: a 2-institution analysis of outcomes. Surgery 151(2):261–267

    Article  PubMed  Google Scholar 

  24. Fernandez HT, Kim PTW, Anthony TL, Hamman BL, Goldstein RM, Testa G (2015) Inferior vena cava reconstruction for leiomyosarcoma of Zone I-III requiring complete hepatectomy and bilateral nephrectomy with autotransplantation. J Surg Oncol 112(5):481–485

    Article  PubMed  Google Scholar 

  25. 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(1):31–36

    Article  CAS  PubMed  Google Scholar 

  26. Kieffer E, Alaoui M, Piette J-C, Cacoub P, Chiche L (2006) Leiomyosarcoma of the inferior vena cava: experience in 22 cases. Ann Surg 244(2):289–295

    Article  PubMed  PubMed Central  Google Scholar 

  27. Bunting B, Marsh JW, Wei L, Hughes C, Gelzinis TA (2017) Surgical resection of a leiomyosarcoma involving atrial reconstruction, cardiopulmonary bypass, and ex-vivo liver resection and reimplantation. J Cardiothorac Vasc Anesth 31(2):637–641

    Article  PubMed  Google Scholar 

  28. Levi Sandri GB, Sulpice L, Boudjema K, Meunier B (2014) Hepatobiliary and pancreatic: leiomyosarcoma of the inferior vena cava. J Gastroenterol Hepatol 29(5):896

    Article  CAS  PubMed  Google Scholar 

  29. Gunasekaran V, Rammohan A, Reddy SM, Rela M (2018) Liver transplantation for inferior vena cava leiomyosarcoma: from a Maslow’s hammer to the Occam’s razor. BMJ Case Rep 28:2018

    Google Scholar 

  30. Ghose J, Bhamre R, Mehta N, Desouza A, Patkar S, Dhareshwar J et al (2018) Resection of the inferior vena cava for retroperitoneal sarcoma: six cases and a review of literature. Indian J Surg Oncol 9(4):538–546

    Article  PubMed  PubMed Central  Google Scholar 

  31. Hines OJ, Nelson S, Quinones-Baldrich WJ, Eilber FR (1999) Leiomyosarcoma of the inferior vena cava: prognosis and comparison with leiomyosarcoma of other anatomic sites. Cancer 85(5):1077–1083

    Article  CAS  PubMed  Google Scholar 

  32. Mingoli A, Feldhaus RJ, Cavallaro A, Stipa S (1991) Leiomyosarcoma of the inferior vena cava: analysis and search of world literature on 141 patients and report of three new cases. J Vasc Surg 14(5):688–699

    Article  CAS  PubMed  Google Scholar 

  33. Cananzi FCM, Mussi C, Bordoni MG, Marrari A, De Sanctis R, Colombo P et al (2016) Role of surgery in the multimodal treatment of primary and recurrent leiomyosarcoma of the inferior vena cava. J Surg Oncol 114(1):44–49

    Article  PubMed  Google Scholar 

  34. Illuminati G, Pizzardi G, Calio’ F, Pacilè MA, Masci F, Vietri F (2016) Outcome of inferior vena cava and noncaval venous leiomyosarcomas. Surgery 159(2):613–620

    Article  PubMed  Google Scholar 

  35. Teixeira FJR, do Couto Netto SD, Perina ALDF, Torricelli FCM, Ragazzo Teixeira L, Zerati AE et al (2017) Leiomyosarcoma of the inferior vena cava: survival rate following radical resection. Oncol Lett 14(4):3909–3916

    Article  PubMed  PubMed Central  Google Scholar 

  36. Sulpice L, Rayar M, Levi Sandri G-B, de Wailly P, Henno S, Turner K et al (2016) Leiomyosarcoma of the inferior vena cava. J Vasc Surg 153(3):161–165

    CAS  Google Scholar 

  37. Elens M, Dusoruth M, Astarci P, Mastrobuoni S, Bosiers MJ, Nardella J et al (2018) Management and outcome of prosthetic vascular graft infections: a single center experience. Vasc Endovasc Surg 52(3):181–187

    Article  Google Scholar 

  38. O’Connor S, Andrew P, Batt M, Becquemin JP (2006) A systematic review and meta-analysis of treatments for aortic graft infection. J Vasc Surg 44(1):38–45

    Article  PubMed  Google Scholar 

  39. Bower TC, Nagorney DM, Cherry KJ, Toomey BJ, Hallett JW, Panneton JM et al (2000) Replacement of the inferior vena cava for malignancy: an update. J Vasc Surg 31(2):270–281

    Article  CAS  PubMed  Google Scholar 

  40. Hicks CW, Glebova NO, Piazza KM, Orion K, Pierorazio PM, Lum YW et al (2016) Risk of venous thromboembolic events following inferior vena cava resection and reconstruction. J Vasc Surg 63(4):1004–1010

    Article  PubMed  Google Scholar 

Download references

Funding

This present work is not affiliated with a source of funding for the research.

Author information

Authors and Affiliations

  1. Service de Chirurgie hépatobiliaire Et Digestive, CHU Rennes, 2 Rue Henri le Guilloux, 35000, Rennes, France

    Elodie Gaignard, Damien Bergeat, Fabien Robin, Lisa Corbière, Michel Rayar & Bernard Meunier

  2. Université de Rennes, 35000, Rennes, France

    Elodie Gaignard, Damien Bergeat, Fabien Robin, Lisa Corbière, Michel Rayar & Bernard Meunier

  3. UMR Inserm 1241, NuMeCan, Nutrition Metabolisme Et Cancer, 35000, Rennes, France

    Damien Bergeat & Fabien Robin

Authors
  1. Elodie Gaignard
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Damien Bergeat
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fabien Robin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lisa Corbière
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michel Rayar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bernard Meunier
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Study concept and design were carried out by EG. Acquisition of data was done by EG. Drafting of the manuscript was carried out by EG, FR, LC. Critical revision of the manuscript for important intellectual content was done by DB, MR. Final revision and final approval for publication were carried out by BM.

Corresponding author

Correspondence to Elodie Gaignard.

Ethics declarations

Conflict of interest

The authors have no conflict of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gaignard, E., Bergeat, D., Robin, F. et al. Inferior Vena Cava Leiomyosarcoma: What Method of Reconstruction for Which Type of Resection?. World J Surg 44, 3537–3544 (2020). https://doi.org/10.1007/s00268-020-05602-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-020-05602-2

Search

Navigation