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Xue G, Wang X, Liu B, Li C, Lv A, Tian X, Wu J, Qiu H, Hao C. Surgical outcomes of major vascular resection for retroperitoneal liposarcoma from a high‑volume sarcoma center: a propensity score matching analysis. J Cancer Res Clin Oncol 2024; 150:343. [PMID: 38981922 PMCID: PMC11233382 DOI: 10.1007/s00432-024-05871-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 06/27/2024] [Indexed: 07/11/2024]
Abstract
PURPOSE Radical resection of retroperitoneal liposarcoma (RLPS) may necessitate vascular resection and reconstruction. The study was conducted to assess surgical outcomes of surgery for RLPS with major vascular involvement. METHODS Patients with RLPS who underwent surgical resection at the Sarcoma Center of Peking University Cancer Hospital between April 2011 and December 2022 were identified from a prospectively maintained database. Patients were classified into two groups: vascular resection and non-vascular resection groups. A propensity score matching analysis was performed to eliminate baseline differences between the groups. Surgical details and postoperative outcomes were analyzed. Furthermore, prognostic factors for local recurrence-free survival (LRFS) and overall survival (OS) were assessed. RESULTS Overall, 199 patients were identified and the median follow-up period was 48 (interquartile range [IQR] 45-69) months. Vascular resection was performed in 42 (21%) patients, 25 of whom had vascular infiltration. A total of 39 patients had vascular replacement and 3 patients underwent partial resection (side-wall resection). Vascular resection was burdened by higher rates of major morbidity (38% vs. 14%, p < 0.001) and 30-day mortality (7.1% vs. 1.3%, p = 0.005). After propensity-matched analysis, patients who underwent vascular resection had 5-year LRFS and OS rates comparable to those without vascular involvement. Major vascular resection was not an independent risk factor for LRFS or OS. CONCLUSIONS Although accompanied by increased risks of major morbidity and mortality, the major vascular resection enabled radical resection in patients with advanced RLPS, affording comparable 5-year LRFS and OS rates compared to those who did not.
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Affiliation(s)
- Guoqiang Xue
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Xiaopeng Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Bonan Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Chengpeng Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Ang Lv
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Xiuyun Tian
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Jianhui Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China
| | - Hui Qiu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China.
| | - Chunyi Hao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Sarcoma Center, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China.
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Yoshizawa K, Ohno Y, Kurata T, Takagi Y, Kasai T, Takizawa M, Soejima Y. Primary leiomyosarcoma of the inferior vena cava in a pediatric case: a case report and literature review. Surg Case Rep 2023; 9:52. [PMID: 37022631 PMCID: PMC10079787 DOI: 10.1186/s40792-023-01630-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/22/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Leiomyosarcoma is classified as a soft tissue sarcoma. In adults, leiomyosarcoma is the most common malignancy affecting the vascular system; however, vascular leiomyosarcoma in children is extremely rare as most pediatric soft tissue tumors are rhabdomyosarcomas. The survival rate is very low, and incomplete resection is a poor prognostic factor. There is also a high rate of distant recurrence, with the lungs and liver being the most common sites of metastasis. There is no established effective chemotherapy, and complete surgical resection is the only potentially curative treatment for leiomyosarcoma. CASE PRESENTATION A 15-year-old female patient with no significant medical history presented with severe upper abdominal pain and was admitted. Abdominal contrast-enhanced computed tomography and magnetic resonance imaging showed a large retroperitoneal tumor protruding into the lumen of the inferior vena cava behind the liver and multiple small nodules, and metastasis to the liver was suspected. The tumor was 6 × 4 × 5 cm in diameter, located just behind the hepatic hilar structures, and was suspected to infiltrate into the right portal vein. The tumor was diagnosed as a leiomyosarcoma through an open tumor biopsy. As the multiple liver metastases were located only in the right lobe of the liver on imaging, we performed tumor resection with right hepatectomy and replacement of the inferior vena cava (IVC). The postoperative course was uneventful; however, on postoperative day 51, distant metastatic recurrences were found in the remaining liver and right lung. The patient was immediately started on chemotherapy and trabectedin proved to be the most effective drug in the treatment regimen; however, severe side effects, such as hepatotoxicity, prevented timely administration, and the patient passed away 19 months after surgery. CONCLUSIONS IVC resection and reconstruction combined with right hepatectomy were able to be safely performed even in a pediatric case. To improve the prognosis of leiomyosarcoma with multiple metastases, an effective treatment strategy combining surgical treatment and chemotherapy, including molecularly targeted drugs, should be established as early as possible.
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Affiliation(s)
- Kazuki Yoshizawa
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan.
| | - Yasunari Ohno
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan
| | - Takashi Kurata
- Department of Hematology/Oncology, Nagano Children's Hospital, 3100 Toyoshina, Azumino, Nagano, Japan
| | - Yuki Takagi
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan
| | - Tomoko Kasai
- Department of Surgery, Nagano Children's Hospital, 3100 Toyoshina, Azumino, Nagano, Japan
| | - Momoko Takizawa
- Department of Laboratory Medicine, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, Nagano, Japan
| | - Yuji Soejima
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, Japan
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3
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Rust DJ, Kato T, Yoon SS. Treatment for local control of retroperitoneal and pelvis sarcomas: A review of the literature. Surg Oncol 2022; 43:101814. [PMID: 35834940 DOI: 10.1016/j.suronc.2022.101814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/21/2022] [Accepted: 07/03/2022] [Indexed: 11/29/2022]
Abstract
Retroperitoneal and pelvis sarcomas are uncommon tumors for which complete surgical resection is the mainstay of treatment. However, achieving complete gross resection with microscopically negative margins is challenging, and local recurrence rates can be high. Patients often succumb to uncontrolled local disease. Radiation therapy offers a potential means for sterilizing microscopic residual disease, although its use continues to be controversial. Chemotherapy alone or in combination with radiation continues to be investigated as an adjunct to surgery, along with immunotherapy and targeted therapies. In this review, we discuss the current management of retroperitoneal and pelvis sarcomas, focusing on studies of surgery and radiation therapy to maximize local control.
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Affiliation(s)
- Dylan J Rust
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Division of Surgical Oncology, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Tomoaki Kato
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Division of Abdominal Organ Transplantation, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
| | - Sam S Yoon
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Division of Surgical Oncology, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA.
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4
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Borghese O, Pisani A, Dubrez J, Di Centa I. Treatment outlines for the management of primary leiomyosarcoma of the inferior vena cava. JOURNAL DE MEDECINE VASCULAIRE 2022; 47:65-70. [PMID: 35691665 DOI: 10.1016/j.jdmv.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/26/2022] [Indexed: 06/15/2023]
Abstract
Primary venous Leiomyosarcoma (LMSs) are extremely rare tumours with poor survival rates. Surgery is currently the only potentially curative therapy in non-metastatic disease, but it consists in challenging interventions. The authors report the experience of one single centre in the treatment of LMS and a literature overview focusing on the diverse methods of vessels repair. Outcomes achieved are also outlined.
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Affiliation(s)
- Ottavia Borghese
- Sapienza University, Rome, Italy; Department of Vascular and Endovascular Surgery, Foch Hospital, Suresnes, France.
| | - Angelo Pisani
- Sapienza University, Rome, Italy; Department of Cardiovascular Surgery, Azienda Ospedaliera Santa Maria della Misericordia, Perugia, Italy
| | - Julien Dubrez
- Department of Gastrointestinal Surgery, Foch Hospital, Suresnes, France
| | - Isabelle Di Centa
- Department of Vascular and Endovascular Surgery, Foch Hospital, Suresnes, France
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5
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Zhang HX, Wang K, Hong P, Lu M, Liu Z, Liu L, Wang GL, Ma LL. Clinical experience with the treatment of retroperitoneal vascular leiomyosarcoma originating from large veins. BMC Surg 2021; 21:326. [PMID: 34392834 PMCID: PMC8364698 DOI: 10.1186/s12893-021-01322-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Retroperitoneal vascular leiomyosarcoma (RVLMS) is an extremely rare disease in clinical practice, and it has poor prognosis. This article is to explore the diagnosis and treatment of RVLMS and present our experience. METHODS Data of RVLMS patients were continuously collected in our hospital from August 2018 to February 2020: two males and two females with a median age of 56 (min-max = 33-61) years were included. Patients in whom paraganglioma could not be excluded were asked to take phenoxybenzamine before surgery. A multi-disciplinary team (MDT) meeting had been held and surgery was recommended. The operation procedures varied based on the tumor location, shape, and stage, and the core steps were "exposure of the retroperitoneum and tumor, identification of vital blood vessels, blocking the bloodstream, complete removal of the tumor and tumor thrombus, and release of blood flow". A Satinsky clamp was used to partially block the blood vessels. Follow-up was conveyed by revisits and phone calls. RESULTS One patient underwent open surgery, and three patients underwent laparoscopic surgery, one of whom underwent conversion to open surgery. The procedures were finished successfully, with a median operative time of 314.5 (min-max = 224-467) mins. The median amount of intraoperative bleeding was 550 (min-max = 200-1500) ml, and three patients had transfusion during the operation. The mass was irregular in shape, with a median maximum size of 7.45 (min-max = 4.2-10.7) cm, and the pathological examination confirmed RVLMS, which has spindle-shape, high mitotic activity and atypia. One week after the operation, the median serum creatinine level was 85 (min-max = 70-99) µmol/L. The median follow-up time was 16 (min-max = 13-21) months, and 1 case reported asymptomatic recurrence. CONCLUSION Uncharacteristic manifestations and imaging features contribute to the problematic diagnosis of RVLMS. Comprehensive preoperative evaluation and careful surgical planning are essential. Multicenter research is needed in the future to reach a dominant consensus.
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Affiliation(s)
- Hong-Xian Zhang
- Department of Urology, Peking University Third Hospital, 100191, Beijing, People's Republic of China
| | - Kai Wang
- Department of Urology, Peking University Third Hospital, 100191, Beijing, People's Republic of China
| | - Peng Hong
- Department of Urology, Peking University Third Hospital, 100191, Beijing, People's Republic of China
| | - Min Lu
- Department of Pathology, Peking University Third Hospital, 100191, Beijing, People's Republic of China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, 100191, Beijing, People's Republic of China
| | - Lei Liu
- Department of Urology, Peking University Third Hospital, 100191, Beijing, People's Republic of China
| | - Guo-Liang Wang
- Department of Urology, Peking University Third Hospital, 100191, Beijing, People's Republic of China.
| | - Lu-Lin Ma
- Department of Urology, Peking University Third Hospital, 100191, Beijing, People's Republic of China.
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Malki Y, Lazaar H, Bouhout T, Serji B, Benzirar A, El Harroudi T. Infrarenal Vena Cava Leiomyosarcoma Treated With Surgical Resection and Vascular Reconstruction. Cureus 2021; 13:e15808. [PMID: 34306875 PMCID: PMC8294025 DOI: 10.7759/cureus.15808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/24/2022] Open
Abstract
Leiomyosarcoma of the inferior vena cava is a rare malignant tumor with a poor prognosis. We report a case of a 39-year-old woman admitted for a surgical resection of a retroperitoneal mass revealed by pain localised in the right lumbar fossa. Computed tomography of the abdomen revealed a heterogeneous retroperitoneal mass compressing the inferior vena cava. Surgical resection was performed with the reconstruction of the inferior vena cava using a Dacron prosthesis, the diagnosis of vessel wall leiomyosarcoma was revealed by histopathology. Surgical resection with clear margins remains the only treatment offering the best survival rate. The complex nature of the surgery of those tumors is a major therapeutic challenge for surgeons.
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Affiliation(s)
- Yosra Malki
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| | - Hatim Lazaar
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| | - Tariq Bouhout
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| | - Badr Serji
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
| | - Adnan Benzirar
- Vascular Surgery, Medical School University Oujda, Oujda, MAR
| | - Tijani El Harroudi
- Surgical Oncology, Mohammed VI University Hospital, Regional Oncology Center, Oujda, MAR
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Tuxun T, Li T, Apaer S, He YB, Bai L, Gu SS, Wang ZP, Huo Q, Wang J, Zhao JM. Ex Vivo Liver Resection and Autotransplantation as Surgical Option for Zone II-III Leiomyosarcoma of IVC: A Case Report and Literature Review. Front Oncol 2021; 11:690617. [PMID: 34178689 PMCID: PMC8226245 DOI: 10.3389/fonc.2021.690617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 05/13/2021] [Indexed: 12/11/2022] Open
Abstract
We report the first documented case of leiomyosarcoma at zone II-III of inferior vena cava with thrombi in three hepatic veins undergoing ex vivo liver resection and autotransplantation (ELRA) and hepatic veins thrombectomy. A 33-year-old female patient presented with abdominal distention and lower extremities edema. Abdominal wall varicosis and shifting dullness were positive on physical examination. Her liver function was classified as Child-Pugh B and a solid tumor at retro-hepatic vena cava extending to right atrium with thrombi in three hepatic veins were confirmed. The diagnosis of leiomyosarcoma with Budd-Chiari syndrome was highly suspected with preoperative ultrasound, echocardiogram, CT scan, and three-dimensional reconstruction. A zone II-III leiomyosarcoma of IVC origin was confirmed at surgery and ex vivo liver resection and autotransplantation, and hepatic vein thrombectomy with atrial reconstruction were performed under cardiopulmonary bypass (CPB). Operative time, anhepatic time, and CPB time were 12 h, 128 min, and 84 min, respectively. The patients experienced post-operative liver dysfunction and was cured with conservative therapy. Hepatic recurrence two years after surgery was managed with radiofrequency. The patient was alive with liver metastasis three years after surgery. Despite being regarded as an extremely aggressive procedure, ELRA could be considered in the treatment of advanced leiomyosarcoma with Budd-Chiari syndrome and hepatic vein thrombi.
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Affiliation(s)
- Tuerhongjiang Tuxun
- Department of Liver Transplantation & Liver Surgery, Center of Organ Transplantation, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Tao Li
- Department of Liver Transplantation & Liver Surgery, Center of Organ Transplantation, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Shadike Apaer
- Department of Liver Transplantation & Liver Surgery, Center of Organ Transplantation, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yi-Biao He
- Department of Liver Transplantation & Liver Surgery, Center of Organ Transplantation, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Lei Bai
- Department of Liver Transplantation & Liver Surgery, Center of Organ Transplantation, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Shen-Sen Gu
- Department of Liver Transplantation & Liver Surgery, Center of Organ Transplantation, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Zhi-Peng Wang
- Department of Liver Transplantation & Liver Surgery, Center of Organ Transplantation, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Qiang Huo
- Department of Cardiac Surgery, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jiang Wang
- Department of Anesthesiology, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Jin-Ming Zhao
- Department of Liver Transplantation & Liver Surgery, Center of Organ Transplantation, 1st Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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8
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Cananzi FCM, Ruspi L, Fiore M, Sicoli F, Quagliuolo V, Gronchi A. Major vascular resection in retroperitoneal sarcoma surgery. Surgery 2021; 170:848-856. [PMID: 33812753 DOI: 10.1016/j.surg.2021.02.052] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/15/2021] [Accepted: 02/17/2021] [Indexed: 11/17/2022]
Abstract
Major blood vessels may be invaded either by primary sarcomas arising from the vessel wall or by secondary infiltration of a retroperitoneal sarcoma. The involvement of major blood vessels is not considered to be an absolute contraindication for surgical resection. The main issue when evaluating a possible major vascular resection is to balance the possible surgical morbidity with the expected survival benefit. This is strictly related to the tumor's biology and clinical behavior and to the patient's performance status and comorbidities. A multidisciplinary approach in a specialized center is mandatory when approaching a possible oncovascular resection for retroperitoneal sarcoma, given the rarity and the heterogeneity of these tumors.
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Affiliation(s)
- Ferdinando Carlo Maria Cananzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy.
| | - Laura Ruspi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Marco Fiore
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federico Sicoli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Vittorio Quagliuolo
- Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Alessandro Gronchi
- Sarcoma Service, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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9
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Oliveira R, Pires V, Macedo C, Madeira J. Unexpected inferior vena cava syndrome: leiomyosarcoma. BMJ Case Rep 2021; 14:14/3/e239839. [PMID: 33782067 PMCID: PMC8009215 DOI: 10.1136/bcr-2020-239839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Leiomyosarcomas arising directly from the blood vessels are rare. These tumours are formed from the muscular wall of either a major vein or artery. The authors describe the case of an 84-year-old woman with lower back pain with bilateral abdominal irradiation and marked peripheral oedema, who was diagnosed with leiomyosarcoma of the inferior vena cava after biopsy of an infrahepatic mass. An endovascular prosthesis was placed as the patient was proposed for palliative care. Leiomyosarcomas of the inferior vena cava may present with non-specific symptoms. Therefore, the authors aim to draw attention to the diagnosis process, as well as imaging findings related to this pathology.
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Affiliation(s)
- Raquel Oliveira
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Verena Pires
- Department of Radiology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Cristiane Macedo
- Department of Internal Medicine, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Joana Madeira
- Department of Pathology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
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10
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Grieff AN, Hamilton C, Ady J, Beckerman WE, Shafritz R, Koshenkov V, Rahimi S. Concomitant Aorto-Caval Reconstruction for Inferior Vena Cava Leiomyosarcoma. Ann Vasc Surg 2020; 70:567.e13-567.e17. [PMID: 32795651 DOI: 10.1016/j.avsg.2020.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/23/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Leiomyosarcoma of the inferior vena cava (IVC) is a rare smooth muscle neoplasm typically presenting in the fifth to sixth decades of life with both intraluminal and extraluminal growth patterns. Surgical resection remains the gold standard for nonmetastatic disease and often requires vascular reconstruction. We present an atypical case of leiomyosarcoma involving both the IVC and infrarenal abdominal aorta necessitating reconstruction with intraoperative veno-venous bypass. METHODS A 63-year-old man initially presenting with back pain was found to have a large mass adjacent to the IVC on MRI, subsequently confirmed to be leiomyosarcoma by biopsy. After 6 months of neoadjuvant chemotherapy, the patient was taken for resection. However, intraoperatively the tumor was found to involve the aorta necessitating combined aorto-caval reconstruction. To facilitate en-bloc resection of the tumor, the aorta was reconstructed first followed by the inferior vena cava using veno-venous bypass. RESULTS Postoperatively, the patient was taken to the intensive care unit for resuscitation and had an uncomplicated hospital course. He was discharged to rehab 6 days postoperatively and at one year remains free of significant tumor burden with patent aorto-caval bypass grafts. CONCLUSIONS Primary leiomyosarcoma of the IVC is estimated to have aortic involvement in <10% of cases and concurrent aorto-caval reconstruction can be a well-tolerated option in good surgical candidates. Furthermore, veno-venous bypass can be a useful tool for accomplishing successful oncologic resections. With interdisciplinary collaboration between surgical oncologists, urologists, and vascular surgeons, difficult pathologies can be addressed with good patient outcomes.
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Affiliation(s)
- Anthony N Grieff
- Department of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Charles Hamilton
- Department of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Justin Ady
- Department of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - William E Beckerman
- Department of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Randy Shafritz
- Department of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Vadim Koshenkov
- Department of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Saum Rahimi
- Department of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
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11
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Liu L, Wang GL, Ma LL, Lu M, Liu C, Hou XF. [Diagnosis and surgical treatment of massive adrenal area tumor with tumor thrombus]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2019; 51:684-688. [PMID: 31420622 DOI: 10.19723/j.issn.1671-167x.2019.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To summarize the experience of diagnosis and operation related to massive adrenal area tumor with venous tumor thrombus in clinic. METHODS From October 2017 to March 2019, a total of 8 cases of massive adrenal area tumor (>7 cm) with venous tumor thrombus were admitted at Peking University Third Hospital including 5 males and 3 females with mean age 50.6 years (31-62 years). There were 6 cases on the right side and 2 cases on the left side. The first symptoms included abdominal discomfort, hypertension, Cushing syndrome and abnormal menstruation; special past history included cirrhosis and lung cancer. Computed tomography (CT) and routine endocrine hormone tests were examined. Preoperative imaging confirmed 5 cases masses with tumor thrombus in inferior vena cava (IVC) and 1 case with tumor thrombus in left renal vein. Two cases presented with tumor thrombus in central adrenal vein were found intraoperatively. Open adrenalectomy and thrombectomy were performed in 4 cases of right side complicated with high tumor thrombus of inferior vena cava. Laparoscopic adrenalectomy and thrombectomy were performed in 3 cases, including 2 cases on the right and 1 case on the left. The case with tumor thrombus in left renal vein gave up operation. The patients were followed up with outpatient and telephone. RESULTS The mean size of the tumor was 8.9 cm (7-11 cm), the mean operative time was 319 min (120-510 min), while the estimated blood loss was 629 mL (50-1 200 mL). Intraoperative blood transfusion was required in 2 cases and 1 case encountered wound infection. The pathological types included pheochromocytoma, adrenocortical carcinoma, adrenal metastases of haptic carcinoma, and leiomyosarcoma. The case with left lung carcinoma who underwent left pneumonectomy one month before was highly suspected adrenal metastases of lung carcinoma. Tumor thrombus of pheochromocytoma was combined with blood thrombus. Capsule of adrenocortical carcinoma was fragile in adrenocortical carcinoma. Abundant blood supply existed in adrenal metastases. The leiomyosarcoma had unabundant blood supply and invaded IVC to form tumors thrombus. The mean follow-up time was 8.4 months (1-15 months). One case with adrenocortical carcinoma died after 1 year in the follow-up. CONCLUSION We present the rare cases of different pathological types of massive adrenal tumors with tumor thrombus extending into the IVC extension or other vein. Preoperative diagnosis needs comprehensive evaluation and perfect preoperative preparation. Surgery is difficult and varied. Open approach as well as retroperitoneal laparoscopic approach is feasible.
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Affiliation(s)
- L Liu
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - G L Wang
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - L L Ma
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - M Lu
- Department of Pathology, Peking University Third Hospital, Beijing 100191, China
| | - C Liu
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - X F Hou
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
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Tzanis D, Bouhadiba T, Gaignard E, Bonvalot S. Major vascular resections in retroperitoneal sarcoma. J Surg Oncol 2017; 117:42-47. [PMID: 29194630 DOI: 10.1002/jso.24920] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/25/2017] [Indexed: 12/12/2022]
Abstract
Retroperitoneal sarcomas (RPS) frequently involve major vessels, which either originate from them or secondarily encase or invade them. In this field, major vascular resections result in increased morbidity. However, survival does not seem to be affected by the need for vascular resection or by this higher morbidity. This paper aims to provide descriptions of the surgical strategy and outcomes for retroperitoneal sarcomas involving major vessels.
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Affiliation(s)
- Dimitri Tzanis
- Department of Surgery, Sarcoma Unit, Institute Curie, PSL University, Paris, France
| | - Toufik Bouhadiba
- Department of Surgery, Sarcoma Unit, Institute Curie, PSL University, Paris, France
| | - Elodie Gaignard
- Department of Surgery, Sarcoma Unit, Institute Curie, PSL University, Paris, France
| | - Sylvie Bonvalot
- Department of Surgery, Sarcoma Unit, Institute Curie, PSL University, Paris, France
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López-Ruiz JA, Tallón-Aguilar L, Marenco-de la Cuadra B, López-Pérez J, Oliva-Mompeán F, Padillo-Ruiz J. Leiomiosarcoma de vena cava inferior. Caso clínico y revisión bibliográfica. CIR CIR 2017; 85:361-365. [DOI: 10.1016/j.circir.2016.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 05/04/2016] [Indexed: 11/30/2022]
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López-Ruiz JA, Tallón-Aguilar L, Marenco-de la Cuadra B, López-Pérez J, Oliva-Mompeán F, Padillo-Ruiz J. Leiomyosarcoma of the inferior vena cava. Case report and literature review. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.circen.2017.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Roland CL, Boland GM, Demicco EG, Lusby K, Ingram D, May CD, Kivlin CM, Watson K, Al Sannaa GA, Wang WL, Ravi V, Pollock RE, Lev D, Cormier JN, Hunt KK, Feig BW, Lazar AJ, Torres KE. Clinical Observations and Molecular Variables of Primary Vascular Leiomyosarcoma. JAMA Surg 2016; 151:347-54. [PMID: 26629783 DOI: 10.1001/jamasurg.2015.4205] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Vascular leiomyosarcomas are a rare subtype of leiomyosarcomas that most commonly affect the inferior vena cava and account for 5% of all leiomyosarcomas. These tumors are aggressive malignant tumors for which adjuvant modalities have not shown increased efficacy compared with surgery. OBJECTIVES To evaluate the outcomes of patients with vascular leiomyosarcoma and the association between vascular leiomyosarcomas and immunohistochemical molecular markers, to determine their potential prognostic and therapeutic utility. DESIGN, SETTING, AND PARTICIPANTS Retrospective medical record review of a cohort of 77 patients who presented to the University of Texas MD Anderson Cancer Center in Houston during the period from January 1993 to April 2012. Data were analyzed during the period from November 2012 to May 2015. All of the patients received a confirmed diagnosis of vascular leiomyosarcoma. Immunohistochemical studies for biomarkers were performed on a tissue microarray that included 26 primary specimens of vascular leiomyosarcoma. MAIN OUTCOMES AND MEASURES Demographic and clinical factors were evaluated to assess clinical course, patterns of recurrence, and survival outcomes for patients with primary vascular leiomyosarcoma. A univariate Cox proportional hazards model was used to correlate disease-specific survival and time to recurrence with potential prognostic indicators. RESULTS Sixty-three patients with localized disease who underwent surgical resection formed the study population, and their data were used for subsequent outcomes analysis. The median age at diagnosis was 58 years (range, 22-78 years). The majority of patients were female (41 patients [65%]) and white (51 patients [81%]). The 5-year disease-specific survival rate after tumor resection was 65%. The median time to local recurrence was 43 months, the median time to distant recurrence was 25 months, and the median time to concurrent local and distant recurrences was 15 months (P = .04). Strong expressions of cytoplasmic β-catenin (hazard ratio, 5.33 [95% CI, 0.97-29.30]; P = .06) and insulinlike growth factor 1 receptor (hazard ratio, 2.74 [95% CI, 1.14-6.56]; P = .02) were associated with inferior disease-specific survival. CONCLUSIONS AND RELEVANCE Vascular leiomyosarcomas are aggressive malignant tumors, with high recurrence rates. Expressions of β-catenin and insulinlike growth factor 1 receptor were associated with poor disease-specific survival. Prospective studies should evaluate the clinical and therapeutic utility of these molecular markers.
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Affiliation(s)
- Christina L Roland
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Genevieve M Boland
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston2Department of Surgery, Massachusetts General Hospital, Boston
| | - Elizabeth G Demicco
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston4Department of Pathology, Mount Sinai Hospital, New York, New York
| | - Kristelle Lusby
- Sarcoma Research Center, University of Texas MD Anderson Cancer Center, Houston
| | - Davis Ingram
- Sarcoma Research Center, University of Texas MD Anderson Cancer Center, Houston
| | - Caitlin D May
- Sarcoma Research Center, University of Texas MD Anderson Cancer Center, Houston6Graduate School of Biomedical Sciences, University of Texas Health Science Center at Houston
| | - Christine M Kivlin
- Sarcoma Research Center, University of Texas MD Anderson Cancer Center, Houston6Graduate School of Biomedical Sciences, University of Texas Health Science Center at Houston
| | - Kelsey Watson
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Ghadah A Al Sannaa
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston
| | - Wei-Lien Wang
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston
| | - Vinod Ravi
- Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | | | - Dina Lev
- Sarcoma Research Center, University of Texas MD Anderson Cancer Center, Houston9Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston
| | - Janice N Cormier
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Kelly K Hunt
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Barry W Feig
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston
| | - Alexander J Lazar
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston
| | - Keila E Torres
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston
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Fujita S, Takahashi H, Kanzaki Y, Fujisaka T, Takeda Y, Ozawa H, Kuwabara H, Katsumata T, Ishizaka N. Primary Leiomyosarcoma in the Inferior Vena Cava Extended to the Right Atrium: A Case Report and Review of the Literature. Case Rep Oncol 2016; 9:599-609. [PMID: 27920691 PMCID: PMC5118828 DOI: 10.1159/000450598] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/06/2016] [Indexed: 12/12/2022] Open
Abstract
A 38-year-old woman had developed an abdominal distention, lower extremity edema, and dyspnea. Imaging examination revealed a large mass in the right atrium which was connected to lesions within the inferior vena cava. Although complete resection of the mass was not possible, partial surgical tumor resection was performed to avoid pulmonary embolization and circulatory collapse. Leiomyosarcoma was diagnosed histologically, and chemotherapy (doxorubicin) followed by radiotherapy was started. By reviewing papers published in the past 10 years that included 322 patients, we also discuss the clinical presentations and prognosis of leiomyosarcoma in the inferior vena cava.
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Affiliation(s)
- Shuichi Fujita
- Department of Cardiology, Osaka Medical College, Osaka, Japan
| | | | - Yumiko Kanzaki
- Department of Cardiology, Osaka Medical College, Osaka, Japan
| | | | | | - Hideki Ozawa
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Osaka, Japan
| | | | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, Osaka, Japan
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Leiomyosarcoma of level II inferior vena cava—an original solution for bilateral renal vein reconstruction. ANGIOLOGIA E CIRURGIA VASCULAR 2016. [DOI: 10.1016/j.ancv.2015.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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[Complex pelvic and sarcoma surgery with vascular replacement]. Chirurg 2015; 87:108-13. [PMID: 26661949 DOI: 10.1007/s00104-015-0123-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Due to optimization of surgical techniques in surgical oncology and vascular surgery, the most modern approaches of anesthesia and intensive care medicine and effective multimodal therapeutic strategies, locally advanced malignant tumors are resected more frequently with a potentially curative intent. In the case of extensive tumors with infiltration of vital vascular structures or of structures which are crucial for extremity preservation, the necessary surgical procedure for complete tumor removal poses a major challenge for the surgeon and incorporates a high risk of perioperative morbidity for the patient. The decision to attempt tumor resection should therefore always be based on a concept considering all aspects of the malignant disease. The treating team should be highly experienced in this complex field of surgery, not only with respect to the surgical approach but also regarding the management of postoperative complications. In this article relevant aspects of decision making, surgical technique and postoperative outcome for malignant tumors involving vascular structures of the retroperitoneum and pelvis are presented.
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Fernandez HT, Kim PTW, Anthony TL, Hamman BL, Goldstein RM, Testa G. Inferior vena cava reconstruction for leiomyosarcoma of Zone I-III requiring complete hepatectomy and bilateral nephrectomy with autotransplantation. J Surg Oncol 2015; 112:481-5. [PMID: 26356493 DOI: 10.1002/jso.24041] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 08/26/2015] [Indexed: 11/06/2022]
Abstract
The inferior vena cava (IVC) is the most common site of leiomyosarcomas arising from a vascular origin. Leiomyosarcomas of the IVC are categorized by anatomical location. Zone I refers to the infrarenal portion of the IVC, Zone II from the hepatic veins to the renal veins, and Zone III from the right atrium to the hepatic veins. This is a rare presentation of a Zone I-III leiomyosarcoma. Fifty-two-years-old female with a medical history significant only for HTN was admitted to the hospital with bilateral lower extremity edema and dyspnea. Two-dimensional echo demonstrated a right atrial thrombus, extending into the IVC. On subsequent CT and MRI, a 15 cm mass was noted that began in the right atrium and extended into the IVC, with continuation below the renal veins to above the level of the confluence of the common iliac veins. The patient underwent a complete resection of the mass, replacement of the IVC with Dacron graft, total hepatectomy and bilateral nephrectomy, with liver and kidney autotransplantation. Pathology was consistent with a high grade spindle cell sarcoma of vena cava origin. Patient was readmitted approximately 4 weeks postoperatively to begin adjuvant chemotherapy. This case represents a zone I-III IVC leiomyosarcoma treated with surgical R0 resection. This included a hepatectomy, bilateral nephrectomy, and hepatic and left renal autotransplantation. These complex tumors should be treated with surgical resection, and require a multidisciplinary approach.
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Affiliation(s)
- Hoylan T Fernandez
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
| | - Peter T W Kim
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
| | - Tiffany L Anthony
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
| | - Baron L Hamman
- Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Robert M Goldstein
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
| | - Giuliano Testa
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas
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22
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Inferior vena cava leiomyosarcoma: preoperative diagnosis and surgical management. Surg Case Rep 2015; 1:35. [PMID: 26943403 PMCID: PMC4747934 DOI: 10.1186/s40792-015-0036-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 03/24/2015] [Indexed: 11/10/2022] Open
Abstract
Inferior vena cava (IVC) leiomyosarcoma is a rare malignant neoplasm more commonly seen in women in the fifth to sixth decade of life. Complete resection of the tumor with negative margins is the only therapeutical option that has demonstrated a survival benefit. This report presents a case of a 67-year-old woman affected by a lower segment IVC leiomyosarcoma incidentally detected during a chronic abdominal pain study. The patient was treated with tumorectomy, resection and ligation of the infrarenal IVC without signs or recurrence on a 12-month follow-up.
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Miles LF, Hu R, Jones RM, Carson S, McCall PR. Inferior Vena Cava Resection and Hemihepatectomy for Leiomyosarcoma, Utilizing Cardiopulmonary Bypass, in Situ Hepatic Perfusion, and Distal Hypothermic Circulatory Arrest. J Cardiothorac Vasc Anesth 2015; 30:169-75. [PMID: 26002188 DOI: 10.1053/j.jvca.2015.01.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Scott Carson
- Department of Cardiac Surgery, Austin Health, Melbourne, Australia
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Mateo Vallejo F, Dominguez Reinado MR, Medina Achirica C, Diaz Oteros M, Esteban Ramos JL, Melero Brenes S. Giant retroperitoneal leiomyosarcoma. Multiorgan block removal. Int J Surg Case Rep 2014; 5:1050-3. [PMID: 25460472 PMCID: PMC4275809 DOI: 10.1016/j.ijscr.2014.10.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 09/12/2014] [Accepted: 10/15/2014] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Retroperitoneal tumors are rare, mostly malignant. Locally aggressive, and more frequent in women in their 5th decade of life. Its symptoms are nonspecific, including abdominal pain and palpable mass. To diagnosis is helpful computed tomography and biopsy. It needs surgery for absolute healing. PRESENTATION OF CASE 67 years old man was admitted with back pain and fever. Abdominal imaging tests showed a 15cm abdominal mass without clear organodependencia. Endoscopy with biopsies evidenced mesenchymal neoplasia of undetermined origin. In surgery we confirm its resecability and was necessary multiorgan resection. Pathologic diagnosis: well differentiated retroperitoneal leiomyosarcoma. Started adjuvant radiotherapy. In subsequent tests showed the presence of liver metastases. DISCUSSION Retroperitoneal tumors are developed from nerve, vascular, muscular, connective, supportive and fibroareolar tissue from this space. Its size does not modificate survival or resectability. We used TC and biopsy for its diagnose. Adjuvant therapy does not affect survival or quality of life, surgery remains the only curative option. Locoregional recurrence is the most influential figure in the prognosis. A large percentage of patients required a second surgery (between 45 and 82%). CONCLUSION The only curative option of retroperitoneal sarcomas is surgery, which usually requires multiple organ resection. Chemotherapy and radiotherapy are mostly a surgical supplement. Chemotherapy has not shown significant increase in survival.
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Affiliation(s)
- F Mateo Vallejo
- Hospital of Jerez de la Frontera, N-IVa Road s/n, Jerez, Cadiz, Spain.
| | | | - C Medina Achirica
- Hospital of Jerez de la Frontera, N-IVa Road s/n, Jerez, Cadiz, Spain
| | - M Diaz Oteros
- Hospital of Jerez de la Frontera, N-IVa Road s/n, Jerez, Cadiz, Spain
| | - J L Esteban Ramos
- Hospital of Jerez de la Frontera, N-IVa Road s/n, Jerez, Cadiz, Spain
| | - S Melero Brenes
- Hospital of Jerez de la Frontera, N-IVa Road s/n, Jerez, Cadiz, Spain
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Jones A, Aziz M. Renal vein reconstruction for primary leiomyosarcoma of the inferior vena cava. ANZ J Surg 2014; 86:729-31. [PMID: 25056428 DOI: 10.1111/ans.12752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Alister Jones
- Vascular Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Maged Aziz
- Vascular Department, St Andrew's Hospital, Toowoomba, Queensland, Australia
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