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Hu H, Guo Q, Zhao J, Huang B, Du X. Aggressive surgical approach with vascular resection and reconstruction for retroperitoneal sarcomas: a systematic review. BMC Surg 2023; 23:275. [PMID: 37700246 PMCID: PMC10498574 DOI: 10.1186/s12893-023-02178-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/31/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND AND AIM Surgery is the mainstay of treatment and completeness of surgical resection is critical to achieve local control for retroperitoneal sarcoma (RPS). En-bloc resection of adjacent organs, including major abdominal vessels, is often required to achieve negative margins. The aim of this review was to summarise the available evidence to assess the relative benefits and disadvantages of an aggressive surgical approach with vascular resection in patients with retroperitoneal sarcoma (RPS). METHODS We searched PubMed, the Cochrane Library, and EMBASE for relevant studies published from inception up to August 1, 2022. We performed a systematic review of the available studies to assess the safety and long-term survival results of vascular resection for RPS. RESULTS We identified a total of 23 studies for our review. Overall postoperative in-hospital or 30-day mortality rate of patients with primary iliocaval leiomyosarcoma was 3% (11/359), and the major complication rate was 13%. The recurrence-free survival (RFS) rates after the follow-up period varied between 15% and 52%, and the 5-year overall survival (OS) rates ranged from 25 to 78%. Overall postoperative in-hospital or 30-day mortality rate of patients with RPSs receiving vascular resection was 3%, and the major complication rate was 27%. The RFS rates after the follow-up period were 18-86%, and the 5-year OS rates varied between 50% and 73%. There were no significant differences in the rates of RFS (HR: 0.97; 95% CI: 0.74-1.19; p = 0.945) and OS (HR: 1.01; 95% CI: 0.66-1.36; p = 0.774) between the extended resection group and tumour resection alone group. CONCLUSIONS With adequate preparation and proper management, for patients with RPSs involving major vessels, aggressive surgical approach with vascular resection can achieve R0/R1 resection and improve survival.
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Affiliation(s)
- Hankui Hu
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Qiang Guo
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
| | - Jichun Zhao
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Bin Huang
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Xiaojiong Du
- Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
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MARTÍN ROMÁN L, FERNÁNDEZ MARTÍNEZ M, PROSPERI A, LOZANO P, VÁSQUEZ W, PALENCIA N, GONZÁLEZ BAYÓN L. Multimodal approach of leiomyosarcoma of the inferior vena cava: case report and literature review of main points of controversy. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.21.05373-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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3
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Liu L, Tang S, Liu Z, Liu C, Zhang H, Tian X, Wang G, Zhang S, Ma L. Robot-Assisted Laparoscopic IVC Treatment Strategy in Retroperitoneal Tumors. Front Oncol 2022; 12:908272. [PMID: 35669432 PMCID: PMC9166303 DOI: 10.3389/fonc.2022.908272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/22/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives To show the practice of robot-assisted laparoscopic inferior vena cava (IVC) treatment strategies in patients with retroperitoneal tumors. Patients and Methods From October 2020 to July 2021, 17 patients with retroperitoneal tumors successfully underwent robot-assisted laparoscopic tumor resection with IVC management. The patient details, tumor characteristics, intraoperative data, pathological features and severe complications were assessed. The IVC treatment strategies were divided into 4 ways: ①local resection and primary repair of the IVC; ②IVC ligation; ③ IVC reconstruction by bovine pericardial grafts; and ④ IVC transection and anastomosis. Results In terms of IVC management, 5 cases had conventional total occlusion of the IVC and its branches, 3 cases had delayed occlusion of the proximal IVC technique, 2 cases had IVC resection by Satinsky clamp, 5 cases had IVC ligation, 1 case had IVC reconstruction by bovine pericardial grafts and 1 case had IVC transection and anastomosis. The median operation time was 151 min, and blood loss was 500 ml. There was no severe complication perioperatively. The follow-up time of 17 patients was 8 to 17 months (median: 12 months). No local recurrence or overall death was found during follow-up. Conclusions These robot-assisted laparoscopic IVC treatment strategies were considered to be safe and feasible in experienced centers, as well as helpful to completely remove the tumor for better oncological prognosis and restore the blood reflux of IVC as much as possible to ensure fewer postoperative complications.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Haidian District, Beijing, China
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4
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Pan J, Qiu CY, He YY, Xue X, Li DL, Tian L, Cheng F, Wu ZH, Zhang HK. A 10-year experience of leiomyosarcoma of the inferior vena cava. Phlebology 2022; 37:572-578. [PMID: 35570826 DOI: 10.1177/02683555221101706] [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: 11/16/2022]
Abstract
OBJECTIVES Leiomyosarcoma of the inferior vena cava (IVC) is rare. The study reviewed patients with IVC leiomyosarcoma in our hospital in the past ten years. METHODS Twenty patients diagnosed with IVC leiomyosarcoma between October 2010 and October 2020 were enrolled. Their clinical manifestations, treatments, and follow-up results were analyzed. RESULTS The sarcoma was located in the lower IVC segment in six patients, with 13 in the middle and one in the upper IVC segment. Eighteen patients underwent R0 resection. After resection, 16 patients (80%) had primary repair of the IVC, while four patients underwent ligation. During a mean follow-up of 37.7 months, seven patients died due to tumor metastasis, four patients were alive with the tumor recurrence and other nine patients were alive without recurrence. CONCLUSION The management of the IVC after tumor resection depended on the tumor location and size. R0 resection provided a chance for long term survival.
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Affiliation(s)
- Jun Pan
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, 71069Zhejiang University, Hangzhou, People's Republic of China
| | - Chen-Yang Qiu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, 71069Zhejiang University, Hangzhou, People's Republic of China
| | - Yang-Yan He
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, 71069Zhejiang University, Hangzhou, People's Republic of China
| | - Xing Xue
- Department of Radiology, The First Affiliated Hospital, School of Medicine, 71069Zhejiang University, Hangzhou, People's Republic of China
| | - Dong-Lin Li
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, 71069Zhejiang University, Hangzhou, People's Republic of China
| | - Lu Tian
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, 71069Zhejiang University, Hangzhou, People's Republic of China
| | - Fei Cheng
- Department of Pathology, The First Affiliated Hospital, School of Medicine, 71069Zhejiang University, Hangzhou, People's Republic of China
| | - Zi-Heng Wu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, 71069Zhejiang University, Hangzhou, People's Republic of China
| | - Hong-Kun Zhang
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, 71069Zhejiang University, Hangzhou, People's Republic of China
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Saikia J, Rastogi S, Barwad A, Dhamija E, Pandey R, Bhoriwal S, Deo S, Kumar S. A systematic review of the current management approaches in leiomyosarcoma of inferior vena cava-Results from analysis of 118 cases. Asian Cardiovasc Thorac Ann 2021; 30:349-363. [PMID: 34672808 DOI: 10.1177/02184923211049911] [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: 11/16/2022]
Abstract
INTRODUCTION Primary intravenous leiomyosarcomas are rare vascular tumors with aggressive disease biology. The diagnosis and management have been challenging as little data exist from large databases. METHODS A literature search was done to identify all cases of primary leiomyosarcomas in the last five years. Clinicopathological features and management strategies were evaluated. RESULTS The median age was 53 years, predominantly females (2.5:1), presenting as metastases in up to 12.1% cases. Most tumors were locally advanced with a median size of 10cm. Inferior vena cava involvement from renal veins to infrahepatic veins remains the most frequent site (57.1%cases) while nearly half (52.8%) proceeded for surgery without histological proof. Most patients could undergo upfront resection (88.0%) with few patients receiving neoadjuvant chemotherapy (4.3%) or neoadjuvant radiotherapy (2.2%). Significant multivisceral resections included right nephrectomy (41.3%), liver resection (25.7%) and left nephrectomy (2.2%). Most patients (91.8%) needed an inferior vena cava graft placement with remarkable microscopically negative margins (85.5% cases). Doxorubicin and ifosfamide were the most frequently used combination chemotherapy regimens in both pre and postoperative settings with partial responses. The median overall and disease free survival among operated patients was 60 months and 28 months respectively. In multivariate analysis large tumor, extensive inferior vena cava involvement, and need for adjuvant chemotherapy appeared significant predictors for overall survival. CONCLUSIONS Aggressive upfront surgical resection with clear margin remains the key for long-term survival. Doxorubicin-based regimens were preferred as neoadjuvant chemotherapy while adjuvant treatment with chemotherapy, radiotherapy, or both may be considered in high-risk patients.
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Affiliation(s)
- Jyoutishman Saikia
- Department of Surgical Oncology, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Rastogi
- Department of Medical Oncology, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Adarsh Barwad
- Department of Pathology, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Ekta Dhamija
- Department of Radiodiagnosis, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Rambha Pandey
- Department of Radiotherapy, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Bhoriwal
- Department of Surgical Oncology, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Suryanarayana Deo
- Department of Surgical Oncology, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
| | - Sunil Kumar
- Department of Surgical Oncology, DRBRA IRCH, 28730All India Institute of Medical Sciences, New Delhi, India
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6
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Sheaffer WW, Davila VJ, Mendes BC, Meltzer AJ, Stone WM, Soh IY, Truty MJ, Nagorney DM, Money SR, Bower TC. Surgical and reconstructive outcomes in primary venous leiomyosarcoma. J Vasc Surg Venous Lymphat Disord 2021; 10:901-907. [PMID: 34352417 DOI: 10.1016/j.jvsv.2021.07.010] [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: 02/21/2020] [Accepted: 07/22/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Primary venous leimyosarcomas (PVL) are rare and pose challenges in surgical management. This study evaluates the clinical outcomes and identifies predictors of survival in our surgical series of PVL. METHODS A retrospective review was performed of patients who had resection of PVL at three centers between 1990-2018. Patient demographics, comorbidities, intraoperative data, survival, and graft related outcomes were recorded. Survival analysis was performed using Kaplan-Meier curves and Cox proportional hazards regression. RESULTS Seventy patients with a diagnosis of PVL were identified between 1990 and 2018. Fifty-four patients (77%) had PVL of the IVC and 16 (23%) had peripheral PVL. Mean follow up for the series was 55.0 months (range 1-217 months). Fifty one patients (96%) with IVC PVL needed caval reconstruction and 3 (4%) had resection only. There were no deaths within thirty days of surgery. Five patients (9%) required early re-intervention including one (2%) IVC stent. Sixteen peripheral PVL were identified. Eight patients (50%) had venous reconstructions performed and 8 (50%) had the vein resected without reconstruction. There were no deaths within thirty days. Five year survival was 57.5% for IVC PVL and 70.0% for peripheral PVL . Kaplan-Meier survival analysis for IVC and peripheral PVL revealed no difference in overall survival (p = 0.624) at 5 years. CONCLUSIONS PVL is a rare and aggressive disease even with surgical resection. We found no difference in survival between IVC and peripheral lesions suggesting aggressive management is warranted for PVL of any origin. Management of PVL requires a multidisciplinary approach to provide patients with the best long term outcomes.
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Affiliation(s)
- William W Sheaffer
- Mayo Clinic Arizona Division of Vascular Surgery, 5777 E Mayo Boulevard, Phoenix, AZ 85054.
| | - Victor J Davila
- Mayo Clinic Arizona Division of Vascular Surgery, 5777 E Mayo Boulevard, Phoenix, AZ 85054
| | - Bernardo C Mendes
- Mayo Clinic Rochester Division of Vascular Surgery, 200 First St. SW, Rochester, MN 55905
| | - Andrew J Meltzer
- Mayo Clinic Arizona Division of Vascular Surgery, 5777 E Mayo Boulevard, Phoenix, AZ 85054
| | - William M Stone
- Mayo Clinic Arizona Division of Vascular Surgery, 5777 E Mayo Boulevard, Phoenix, AZ 85054
| | - Ina Y Soh
- Mayo Clinic Arizona Division of Vascular Surgery, 5777 E Mayo Boulevard, Phoenix, AZ 85054
| | - Mark J Truty
- Mayo Clinic Rochester Department of General Surgery Subspecialties, 200 First St. SW, Rochester, MN 55905
| | - David M Nagorney
- Mayo Clinic Rochester Department of General Surgery Subspecialties, 200 First St. SW, Rochester, MN 55905
| | - Samuel R Money
- Mayo Clinic Arizona Division of Vascular Surgery, 5777 E Mayo Boulevard, Phoenix, AZ 85054
| | - Thomas C Bower
- Mayo Clinic Rochester Division of Vascular Surgery, 200 First St. SW, Rochester, MN 55905
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Rusu CB, Gorbatâi L, Szatmari L, Koren R, Bungărdean CI, Feciche BO, Bumbuluţ C, Andraş IM, Rahotă R, Telecan T, Coman I, Rath-Wolfson L, Crişan N. Leiomyosarcoma of the inferior vena cava. Our experience and a review of the literature. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:227-233. [PMID: 32747914 PMCID: PMC7728114 DOI: 10.47162/rjme.61.1.25] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Leiomyosarcoma (LMS) of the inferior vena cava (IVC) is a rare malignant tumor, accounting for 2% of all LMSs. Less than 400 cases have been reported in literature. Computed tomography (CT) is the most accurate imaging method in assessing the location of the tumor within the IVC and magnetic resonance imaging (MRI) accurately identifies its extent and the potential for surgical resection. We present the case of a patient with inferior vena cava leiomyosarcoma (IVCL), for whom the pathological diagnosis was different from the initially expected one, the tumor appearance on pre-operative imaging mimicking renal cell carcinoma. The intraoperative difficulty of approaching renal hilum and IVC was a factor suggesting the vascular origin of the tumor, which was confirmed at pathological analysis. The extensive defect in the IVC after tumor excision led to the decision of complete transverse suturing of IVC, as significant collateral venous circulation was already present. Because IVCL is a rare disease, there is scarce data regarding the prognosis and treatment options. Long-term survival depends on the extent of the surgery. The need of vascular reconstruction is not always mandatory. Despite high recurrence rates, no consensus regarding adjuvant treatment exists yet. A multidisciplinary approach including surgical oncologists and vascular surgeons is mandatory to achieve the best patient outcomes. Perioperative planning, coordination and adherence to oncological techniques are critical.
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Affiliation(s)
- Cristian Bogdan Rusu
- Department of Urology, Iuliu Haţieganu University of Medicine and Pharmacy, Municipal Clinical Hospital, Cluj-Napoca, Romania;
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Gaignard E, Bergeat D, Robin F, Corbière L, Rayar M, Meunier B. Inferior Vena Cava Leiomyosarcoma: What Method of Reconstruction for Which Type of Resection? World J Surg 2021; 44:3537-3544. [PMID: 32445073 DOI: 10.1007/s00268-020-05602-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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.
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Affiliation(s)
- Elodie Gaignard
- Service de Chirurgie hépatobiliaire Et Digestive, CHU Rennes, 2 Rue Henri le Guilloux, 35000, Rennes, France.
- Université de Rennes, 35000, Rennes, France.
| | - Damien Bergeat
- Service de Chirurgie hépatobiliaire Et Digestive, CHU Rennes, 2 Rue Henri le Guilloux, 35000, Rennes, France
- Université de Rennes, 35000, Rennes, France
- UMR Inserm 1241, NuMeCan, Nutrition Metabolisme Et Cancer, 35000, Rennes, France
| | - Fabien Robin
- Service de Chirurgie hépatobiliaire Et Digestive, CHU Rennes, 2 Rue Henri le Guilloux, 35000, Rennes, France
- Université de Rennes, 35000, Rennes, France
- UMR Inserm 1241, NuMeCan, Nutrition Metabolisme Et Cancer, 35000, Rennes, France
| | - Lisa Corbière
- Service de Chirurgie hépatobiliaire Et Digestive, CHU Rennes, 2 Rue Henri le Guilloux, 35000, Rennes, France
- Université de Rennes, 35000, Rennes, France
| | - Michel Rayar
- Service de Chirurgie hépatobiliaire Et Digestive, CHU Rennes, 2 Rue Henri le Guilloux, 35000, Rennes, France
- Université de Rennes, 35000, Rennes, France
| | - Bernard Meunier
- Service de Chirurgie hépatobiliaire Et Digestive, CHU Rennes, 2 Rue Henri le Guilloux, 35000, Rennes, France
- Université de Rennes, 35000, Rennes, France
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9
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Joung HS, Nooromid MJ, Eskandari MK, Wayne JD. Surgical approach, management, and oncologic outcomes of primary leiomyosarcoma of the inferior vena cava: An institutional case series. J Surg Oncol 2020; 122:1348-1355. [DOI: 10.1002/jso.26163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 07/25/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Hae Soo Joung
- Division of Surgical Oncology Northwestern University Feinberg School of Medicine Chicago Illinois
| | - Michael J. Nooromid
- Division of Vascular Surgery Northwestern University Feinberg School of Medicine Chicago Illinois
| | - Mark K. Eskandari
- Division of Vascular Surgery Northwestern University Feinberg School of Medicine Chicago Illinois
| | - Jeffrey D. Wayne
- Division of Surgical Oncology Northwestern University Feinberg School of Medicine Chicago Illinois
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Keller K, Jacobi B, Jabal M, Stavrou GA. Leiomyosarcoma of the inferior vena cava: A case report of a rare tumor entity. Int J Surg Case Rep 2020; 71:50-53. [PMID: 32438337 PMCID: PMC7240060 DOI: 10.1016/j.ijscr.2020.04.094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/18/2020] [Accepted: 04/27/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Leiomyosarcomas are rare and heterogeneous group of tumors that account for less than 1% of adult malignancies. More than 50% of all vascular leiomyosarcomas occur in the lower part of vena cava. Since the first description of Perl and Virchow in 1871, only approximately 450 cases have been reported in literature. PRESENTATION OF CASE The patient presented due to abdominal pain and weight loss. Based on the imaging evaluations a retroduodenal tumor with compression of the inferior vena cava was observed. In the explorative laparotomy a leiomyosarcoma originating from the inferior vena cava was identified. Considering the extensive intramural and intraluminal tumor manifestation, the patient underwent a segmental resection of the vena cava. Reconstruction was achieved by implanting a polytetrafluoroethylene (PTFE) prosthesis. Postoperatively a stenosis developed due to a pericaval haematoma with consecutive compression of the prosthesis. An angiographic implantation of a stent was successfully performed. In the 24-month follow-up, the patient is free of symptoms and tumors. DISCUSSION Leiomyosarcomas of the vena cava are classified anatomically according to their relationship to the liver and renal vessels. The clinical symptoms depend on the affected segment. The therapy of choice is radical en bloc tumor resection. After resection, the options for reconstruction include placement of a synthetic graft, primary repair and patch repair. CONCLUSION Due to a variety of topographic and tumor biological sarcoma manifestations, no standard has been established for the resection of this entity. The extent of resection should be planned individually.
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Affiliation(s)
- Kira Keller
- Department of General, Visceral, Thoracic, and Oncologic Surgery, Klinikum Saarbrücken, Germany.
| | - Barbara Jacobi
- Department of General, Visceral, Thoracic, and Oncologic Surgery, Klinikum Saarbrücken, Germany
| | - Mahmoud Jabal
- Department of General, Visceral, Thoracic, and Oncologic Surgery, Klinikum Saarbrücken, Germany
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Papamichail M, Marmagkiolis K, Pizanias M, Koutserimpas C, Heaton N. Safety and Efficacy of Inferior Vena Cava Reconstruction During Hepatic Resection. Scand J Surg 2018; 108:194-200. [DOI: 10.1177/1457496918798213] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background and Aims: Patients with liver tumors involving the inferior vena cava have a poor outcome without surgery. Liver resection en bloc with inferior vena cava resection and reconstruction is now performed in many centers. The purpose of this study is to investigate the safety and efficacy of inferior vena cava reconstruction during hepatic resection. Materials and Methods: A review of 12 centers reporting 240 patients with combined hepatectomy and inferior vena cava resection and reconstruction for malignant tumors was performed. Sample size, patient characteristics, histological type of the tumor, method of reconstruction, complications, and long-term survival (1-, 2-, and 5-year survival) were evaluated. Results: A total of 240 patients from 12 institutions (male 58%) with mean age 54 years underwent combined liver resection and inferior vena cava resection and reconstruction for colorectal liver metastases (43%), cholangiocarcinomas (26%), hepatocellular carcinomas (19%), leiomyosarcomas (4%), and other tumors (7.9%). Reconstruction included primary closure (35.8%), patch repair (13.3%), or interposition graft (50.8%) In-hospital mortality was 6.25% and overall morbidity was 42.1%. 1- and 10-year survival rates were 79.7% and 28.9%, respectively. Conclusion: Tumors arising in or extending to inferior vena cava that require liver resection should be considered for surgery as it can be performed with an acceptable mortality and morbidity in centers with liver transplantation and hepato-pancreato-biliary facilities.
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Affiliation(s)
- M. Papamichail
- Department of Transplantation and Hepatopancreatobiliary Surgery, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - K. Marmagkiolis
- Department of Interventional Cardiology, Premier Heart and Vascular Group, Pepin Heart Institute, Florida Hospital, Tampa, FL, USA
| | - M. Pizanias
- Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver Studies, Kings Health Partners at King’s College Hospital NHS Trust, London, UK
| | - C. Koutserimpas
- 2nd Department of General Surgery, Sismanogleio General Hospital, Athens, Greece
| | - N. Heaton
- Department of Liver Transplant and Hepato-Pancreato-Biliary Surgery, Institute of Liver Studies, Kings Health Partners at King’s College Hospital NHS Trust, London, UK
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12
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Blair AB, Reames BN, Singh J, Gani F, Overton HN, Beaulieu RJ, Lum YW, Black JH, Johnston FM, Ahuja N. Resection of retroperitoneal sarcoma en-bloc with inferior vena cava: 20 year outcomes of a single institution. J Surg Oncol 2018; 118:127-137. [PMID: 29878363 DOI: 10.1002/jso.25096] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 04/17/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Margin negative resection offers the best chance of long-term survival in retroperitoneal sarcoma (RPS). En-bloc resection of adjacent structures, including the inferior vena cava (IVC), is often required to achieve negative margins. We review our 20-year experience of en-bloc IVC and RPS resection. METHODS Retrospective review of patients with RPS resection involving the IVC were matched 1:3 by age and histology to RPS without IVC resection. Prognostic factors for overall survival (OS) and disease free survival (DFS) were assessed. RESULTS Thirty-two patients underwent RPS resection en-bloc with IVC. They were matched with 96 cases of RPS without IVC resection. Median OS of 59 months and DFS 18 months in IVC resection group was comparable to RPS resection without vascular involvement: median OS 65 months, DFS 18 months (P = 0.519, P = 0.604). On multivariate analyses, R2 margin (OS: HR = 6.52 [95%CI: 1.18-36.09], P = 0.032) was associated with inferior OS. R2 margin and increased number of organs resected (DFS: HR = 5.07, [1.15-22.27], P = 0.031, HR = 1.28 [1.01-1.62], P = 0.014) were associated with inferior DFS. Reconstructions included graft (n = 19, 59%), patch (n = 4, 13%), primary repair (n = 6, 19%), and ligation (n = 4, 13%). CONCLUSIONS RPS resection en-bloc with IVC can achieve equivalent rates of DFS and OS to patients without vascular involvement.
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Affiliation(s)
- Alex B Blair
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Bradley N Reames
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Jasvinder Singh
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Faiz Gani
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Heidi N Overton
- Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Ying W Lum
- Department of Vascular Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - James H Black
- Department of Vascular Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Nita Ahuja
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
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Liu D, Ren HL, Liu B, Shao J, Chen YX, Song XJ, Liu ZL, Chen Y, Li YJ, Liu CW, Zheng YH. Renal Function Preservation in Surgical Resection of Primary Inferior Vena Cava Leiomyosarcoma Involving the Renal Veins. Eur J Vasc Endovasc Surg 2018; 55:229-239. [PMID: 29305094 DOI: 10.1016/j.ejvs.2017.11.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 11/30/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This retrospective study aimed to show the practice of preserving renal function during curative resection of inferior vena cava leiomyosarcoma (IVCL) involving the renal veins at a single institution over a 7 year period. MATERIALS AND METHODS From February 2009 to February 2017, 10 patients (6 women; median age 49 years) with IVCL involving the renal veins were treated surgically at Peking Union Medical College Hospital. En bloc resections were performed in all patients, and the renal outflows were preserved in eight patients using a new method: venoplasty of the renal ostia (VRO). Data regarding patient details, pre-operative preparation, surgical procedures, post-operative recovery, and follow-up results were obtained and reviewed retrospectively. RESULTS Computed tomography and intra-operative examinations revealed that renal vein confluences were involved but not invaded in all cases except Patient 4. All patients underwent curative en bloc tumour excision; a right nephrectomy was performed in only one patient (Patient 4) whose tumour invaded the right renal vein. The mean operation time was 358 min and the mean blood loss 1935 mL. At a median follow-up of 54.5 months, the 5 year local recurrence, distant metastasis, overall survival, and disease-free survival rates were 20%, 10%, 68.6%, and 38.1%, respectively. CONCLUSIONS Venoplasty of the renal ostia is an effective method of preserving the renal veins and reconstructing renal outflow.
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Affiliation(s)
- Duan Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Hua-Liang Ren
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Bao Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Jiang Shao
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yue-Xin Chen
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Xiao-Jun Song
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Zhi-Li Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yu Chen
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yong-Jun Li
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Chang-Wei Liu
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Yue-Hong Zheng
- Department of Vascular Surgery, Peking Union Medical College Hospital, Beijing, China.
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14
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Macarenco RS, Filippi RZ, D'Almeida Costa F, Jesus-Garcia R. Leiomyosarcoma of the great saphenous vein (vena saphena magna) with granular cell change: Report of a superficial neoplasm. J Cutan Pathol 2017; 45:141-145. [PMID: 29068077 DOI: 10.1111/cup.13062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 10/08/2017] [Accepted: 10/19/2017] [Indexed: 11/29/2022]
Abstract
The great saphenous vein (GSV) corresponds to the main superficial large-caliber vessel affected by leiomyosarcoma (LMS). Given its superficial location and because signs of vascular origin may not be clinically apparent, LMS of the GSV may be misinterpreted clinically as superficial nonvascular soft tissue mass. Herein, we report a case on the distal portion of the right GSV of a 57-year-old man. The histopathological recognition of a large-caliber vein-associated LMS (with granular cell change) in an incisional biopsy specimen was crucial to guide radiological evaluation and confirmation of a superficial vascular LMS before surgical treatment. Recognizing this entity in small biopsies is important as its surgical treatment and prognosis differ substantially from nonvascular superficial (ie, subcutaneous and dermal) LMSs. In addition, because vascular LMSs can involve long vessel segments, underestimation of extent of disease is a risk. To the best of our knowledge, granular cell change has not been documented in LMS of the GSV.
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Affiliation(s)
- Ricardo S Macarenco
- Department of Pathology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Renee Z Filippi
- Department of Pathology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Reynaldo Jesus-Garcia
- Orthopedic Oncology Department, Hospital Israelita Albert Einstein, Centro de Oncologia e Hematologia Família Dayan Daycoval, São Paulo, Brazil
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15
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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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