Short- and Long-term Results of Complete Resection and Vascular Reconstruction for Infrahepatic Inferior Vena Cava Leiomyosarcomas: A Retrospective Case Series of 33 Patients.
Inferior vena cava (IVC) leiomyosarcoma is a rare malignant tumor, with fewer than 500 cases described in literature. Prognosis is poor, and radical surgical resection remains the gold standard of treatment. However, the optimal surgical technique is a subject of ongoing debate.
From October 1993 to December 2024, 33 patients (23 females, 10 males; median age 52.2 years) underwent surgical resection of IVC leiomyosarcoma with vascular reconstruction using a polytetrafluoroethylene (PTFE) graft. A multidisciplinary team evaluated all patients. The surgical procedure involved en bloc resection of the tumor with a minimum 1 cm healthy margin. The reconstruction was cavo-caval, cavo-bi-iliac, cavo-caval with right renal vein resection and right nephrectomy and cavo-caval with left renal vein resection and reimplantation. Study's primary endpoints were overall survival, disease-free survival and graft patency. Secondary endpoints were intraoperative and postoperative complications.
No 30-day postoperative mortality was observed. Five- and 10-year survival rates were 57.7% and 15.2%, respectively. Five- and 10-year disease-free survival rates were 36.4% and 18.2%, respectively. Graft thrombosis was observed in 13 patients (39.4%). Median follow-up was 48 months (range=12-120 months; IQR=24.0-68.5). No cases of prosthetic infection or acute graft thrombosis were observed in this series. Postoperative complications included acute kidney injury (AKI) in four patients (12.1%), respiratory distress in two patients (6.1%) distress and postoperative bleeding in three patients (9.1%).
Type I and II IVC leiomyosarcomas resection with subsequent PTFE vascular reconstruction is safe, with a low rate of disease-free survival and a risk of graft thrombosis at medium follow-up.
From October 1993 to December 2024, 33 patients (23 females, 10 males; median age 52.2 years) underwent surgical resection of IVC leiomyosarcoma with vascular reconstruction using a polytetrafluoroethylene (PTFE) graft. A multidisciplinary team evaluated all patients. The surgical procedure involved en bloc resection of the tumor with a minimum 1 cm healthy margin. The reconstruction was cavo-caval, cavo-bi-iliac, cavo-caval with right renal vein resection and right nephrectomy and cavo-caval with left renal vein resection and reimplantation. Study's primary endpoints were overall survival, disease-free survival and graft patency. Secondary endpoints were intraoperative and postoperative complications.
No 30-day postoperative mortality was observed. Five- and 10-year survival rates were 57.7% and 15.2%, respectively. Five- and 10-year disease-free survival rates were 36.4% and 18.2%, respectively. Graft thrombosis was observed in 13 patients (39.4%). Median follow-up was 48 months (range=12-120 months; IQR=24.0-68.5). No cases of prosthetic infection or acute graft thrombosis were observed in this series. Postoperative complications included acute kidney injury (AKI) in four patients (12.1%), respiratory distress in two patients (6.1%) distress and postoperative bleeding in three patients (9.1%).
Type I and II IVC leiomyosarcomas resection with subsequent PTFE vascular reconstruction is safe, with a low rate of disease-free survival and a risk of graft thrombosis at medium follow-up.
Authors
Nardi Nardi, Rinaldi Rinaldi, Iacoucci Iacoucci, D'Onofrio D'Onofrio, Marcelli Marcelli, Nicolis Nicolis, Mayblum Mayblum, Petrucci Petrucci, Coletta Coletta, Pasqua Pasqua, Palumbo Palumbo, Prezioso Prezioso, D'Andrea D'Andrea, Ricco Ricco, Illuminati Illuminati
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