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Lazar D, Stefan D, Marko D, Zlatanovic P, Sladojevic M, Ilijas C, Grubor N, Andreja D. Case series of the inferior vena cava primary leiomyosarcoma treatment. J Surg Case Rep 2024; 2024:rjad546. [PMID: 38840898 PMCID: PMC11151786 DOI: 10.1093/jscr/rjad546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/04/2023] [Indexed: 06/07/2024] Open
Abstract
Tumors of the inferior vena cava (IVC) are rare and usually malignant and they can be primary and secondary. The most common primary tumor of the IVC is primary leiomyosarcoma. The first case of primary IVC leiomyosarcoma has been described in 1871 [1].The total number of 218 cases has collected until 1996 [2]. After that, three large single center series of these tumors emerged [3-5]. Present a series of five cases of these tumors. All the patients underwent a wide complete resection of tumors and the reconstruction with Dacron grafts. One patient died 19 months after the surgery, while the remaining ones survived without a local and system disease relapse. Although a surgical resection combined with the chemotherapy is often not curative, it can achieve a significant long-term survival. For this reason, we recommend the aggressive surgical management using the modern vascular surgical and oncology techniques.
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Affiliation(s)
- Davidovic Lazar
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Koste Todorovića Street 8, Belgrade 11000, Serbia
| | - Ducic Stefan
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dragas Marko
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Koste Todorovića Street 8, Belgrade 11000, Serbia
| | | | - Milos Sladojevic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Koste Todorovića Street 8, Belgrade 11000, Serbia
| | - Cinara Ilijas
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikica Grubor
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Digestive Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Dimic Andreja
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Vascular and Endovascular Surgery, University Clinical Center of Serbia, Koste Todorovića Street 8, Belgrade 11000, Serbia
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2
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Delcarro A, Coubeau L. Inferior vena cava reconstruction with non-fascial autologous peritoneum: Retrospective study and literature review. World J Surg 2024; 48:978-988. [PMID: 38502051 DOI: 10.1002/wjs.12127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/25/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Inferior vena cava (IVC) resection is essential for complete (R0) excision of some malignancies. However, the optimal material for IVC reconstruction remains unclear. Our objective is to demonstrate the efficacy, safety, and advantages of using Non-Fascial Autologous Peritoneum (NFAP) for IVC reconstruction. To conduct a literature review of surgical strategies for tumors involving the IVC. METHODS We reviewed all IVC reconstructions performed at our institution between 2015 and 2023. Preoperative, operative, postoperative, and follow-up data were collected and analyzed. RESULTS A total of 33 consecutive IVC reconstructions were identified: seven direct sutures, eight venous homografts (VH), and 18 NFAP. With regard to NFAP, eight tubular (mean length, 12.5 cm) and 10 patch (mean length, 7.9 cm) IVC reconstructions were performed. Resection was R0 in 89% of the cases. Two patients had Clavien-Dindo grade I complications, 2 grade II, 2 grade III and 2 grade V complications. The only graft-related complication was a case of early partial thrombosis, which was conservatively treated. At a mean follow-up of 25.9 months, graft patency was 100%. There were seven recurrences and six deaths. Mean overall survival (OS) was 23.4 months and mean disease-free survival (DFS) was 14.4 months. According to our results, no statistically significant differences were found between NFAP and VH. CONCLUSIONS NFAP is a safe and effective alternative for partial or complete IVC reconstruction and has many advantages over other techniques, including its lack of cost, wide and ready availability, extreme handiness, and versatility. Further comparative studies are required to determine the optimal technique for IVC reconstruction.
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Affiliation(s)
| | - Laurent Coubeau
- Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
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Voit A, Commander SJ, Williams Z. Partial Inferior Vena Cava Reconstruction with Cryopreserved Aortic Homograft Following Resection for Malignancy. Vasc Endovascular Surg 2022; 57:79-82. [DOI: 10.1177/15385744221124297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Malignant invasion of the inferior vena cava (IVC) often necessitates complete tumor thrombectomy and IVC reconstruction. Bovine pericardial xenografts and prosthetic grafts are frequently used for partial or entire IVC reconstruction with adequate subsequent patency and freedom from thrombosis. Cryopreserved aortic homografts represent an alternative conduit for vena cava replacement with resistance to infection in contaminated fields or following extensive retroperitoneal dissection. Specific reports of aortic homograft use for IVC reconstruction are scarce. Described are 2 cases of cryopreserved aortoiliac artery allograft use for long segment cava patch repair while avoiding extensive caval reconstruction, mobilization and the need for renal vein and hepatic vein re-implantation.
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Affiliation(s)
- Antanina Voit
- Division of Vascular and Endovascular Surgery, Duke University Medical Center, Durham, NC, USA
| | - Sarah Jane Commander
- Division of Vascular and Endovascular Surgery, Duke University Medical Center, Durham, NC, USA
| | - Zachary Williams
- Division of Vascular and Endovascular Surgery, Duke University Medical Center, Durham, NC, USA
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5
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Nooromid M, De Martino R, Squizzato F, Benedetto F, De Caridi G, Chou EL, Conrad MF, Pantoja J, Abularrage C, Sorber R, Garcia-Ortega DY, Luna-Ortiz K, Eichler C, Zarkowsky D, Chia M, Kalluri A, Cohnert T, Szeberin Z, Grotemeyer D, Shalhub S, Fagg D, Jackson MJ, Charlton-Ouw K, Gombert A, Jacobs M, Boyd A, Motaganahalli R, Uceda D, Woo K, Eskandari MK. Surgical resection and graft replacement for primary inferior vena cava leiomyosarcoma: a multicenter experience. J Vasc Surg Venous Lymphat Disord 2021; 10:617-625. [PMID: 34271247 DOI: 10.1016/j.jvsv.2021.06.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/30/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Primary leiomyosarcoma of the inferior vena cava (IVC) is best managed with surgical resection when technically feasible. However, consensus is lacking regarding the best choice of conduit and reconstruction technique. The aim of the present multicenter study was to perform a comprehensive assessment through the VLFDC (Vascular Low Frequency Disease Consortium) to determine the most effective method for caval reconstruction after resection of primary leiomyosarcoma of the IVC. METHODS A multicenter, standardized database review of patients who had undergone surgical resection and reconstruction of the IVC for primary leiomyosarcoma from 2007 to 2017 was performed. The demographics, periprocedural details, and postoperative outcomes were analyzed. RESULTS A total of 92 patients (60 women and 32 men), with a mean age of 60.1 years (range, 30-88 years) were treated. Metastatic disease was present in 22%. The tumor location was below the renal veins in 49 (53%), between the renal and hepatic veins in 52 (57%), and above the hepatic veins in 13 patients (14%). The conduits used for reconstruction included ringed polytetrafluoroethylene (PTFE; n = 80), nonringed PTFE (n = 1), Dacron (n = 1), autogenous vein (n = 1), bovine pericardium (n = 4), and cryopreserved tissue (n = 5). Complete R0 resection was accomplished in 73 patients (79%). In-hospital mortality was 2%, with a median length of stay of 8 days. The primary patency of PTFE reconstructed IVCs was 97% and 92% at 1 and 5 years, respectively, compared with 73% at 1 and 5 years for the non-PTFE reconstructed IVCs. The overall 1-, 3-, and 5-year survival for the entire cohort were 94%, 86%, and 65%, respectively CONCLUSIONS: The findings from our multi-institutional study have demonstrated that complete en bloc resection of IVC leiomyosarcoma with vascular surgical reconstruction in selected patients results in low perioperative mortality and is associated with excellent long-term patency. A ringed PTFE graft was the most commonly used conduit for caval reconstruction, yielding excellent long-term primary patency.
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Affiliation(s)
- Michael Nooromid
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill; Division of Vascular and Endovascular Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Randall De Martino
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Francesco Squizzato
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Filippo Benedetto
- Division of Vascular and Endovascular Surgery, University of Messina, Messina, Italy
| | - Giovanni De Caridi
- Division of Vascular and Endovascular Surgery, University of Messina, Messina, Italy
| | - Elizabeth L Chou
- Division of Vascular Surgery and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Mark F Conrad
- Division of Vascular Surgery and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Joe Pantoja
- Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine, Los Angeles, Calif
| | - Christopher Abularrage
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md
| | - Rebecca Sorber
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md
| | - Dorian Yarih Garcia-Ortega
- Department of Skin and Soft Tissue Tumors and Head and Neck, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Kuauhyama Luna-Ortiz
- Department of Skin and Soft Tissue Tumors and Head and Neck, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Charles Eichler
- Division of Vascular Surgery and Endovascular Therapy, University of California, San Francisco, San Francisco, Calif
| | - Devin Zarkowsky
- Division of Vascular Surgery and Endovascular Therapy, University of California, San Francisco, San Francisco, Calif
| | - Matthew Chia
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Aravind Kalluri
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Tina Cohnert
- Department of Vascular Surgery, Graz Medical University, Graz, Austria
| | - Zoltan Szeberin
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Dirk Grotemeyer
- Department of Vascular Surgery, Hopitaux Robert Schuman, Hopital Kirchberg, Luxembourg City, Luxembourg
| | - Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Wash
| | - Damen Fagg
- Department of Vascular Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Mark J Jackson
- Department of Vascular Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Kristofer Charlton-Ouw
- Department of Clinical Sciences, University of Houston College of Medicine and Gulf Coast Vascular, HCA Houston Healthcare, Gulf Coast Division, Houston, Tex
| | - Alexander Gombert
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Michael Jacobs
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - April Boyd
- Division of Vascular Surgery, Department of Surgery, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Raghu Motaganahalli
- Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Domingo Uceda
- Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Karen Woo
- Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine, Los Angeles, Calif
| | - Mark K Eskandari
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.
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Nooromid MJ, Caicedo JC, Pham DT, Kundu SD, Eskandari MK. Successful Resection of a Retrohepatic Inferior Vena Cava Primary Leiomyosarcoma with Atrial Thrombus Extension in a 30-Week Pregnant Woman. Ann Vasc Surg 2020; 68:567.e11-567.e15. [PMID: 32428643 DOI: 10.1016/j.avsg.2020.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/02/2020] [Indexed: 12/12/2022]
Abstract
Leiomyosarcomas are an uncommon malignant subset of tumors accounting for approximately 20% of soft tissue sarcomas. Primary vascular leiomyosarcomas (PVLs) are a rare subset of leiomyosarcomas that may originate in the arterial or venous circulation but most commonly affect the inferior vena cava (IVC). PVLs more commonly affect women to men in a 2:1 ratio and most frequently occur in the fourth to sixth decades of life. Few reports have described this infrequent pathologic state in the setting of advanced pregnancy. Presented is a case of a 44-year-old 30-week pregnant woman who presented with a PVL of the retrohepatic IVC, which was complicated by occlusion of the IVC and tumor thrombus extension into the hepatic veins and right atrium. Herein, we describe our multidisciplinary management of this rare problem with successful surgical resection of her tumor and IVC reconstruction.
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Affiliation(s)
- Michael J Nooromid
- Division of Vascular Surgery, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Juan C Caicedo
- Division of Transplantation Surgery, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Duc T Pham
- Division of Cardiac Surgery, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Shilajit D Kundu
- Department of Urology, Northwestern Feinberg School of Medicine, Chicago, IL
| | - Mark K Eskandari
- Division of Vascular Surgery, Northwestern Feinberg School of Medicine, Chicago, IL.
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