Surgical treatment of the inferior vena cava (IVC) leiomyosarcoma

Keywords: leiomyosarcoma, vena cava superior, circular resection, prosthesis, іmplantation of renal veins

Abstract

Objective. To propose and introduce a diagnostic-treatment algorithm for the inferior vena cava (IVC) leiomyosarcoma into clinical practice.

Materials and methods. During last 30 years in Zakarpattya Regional Clinical Hospital Named After Andriy Novak and Zakarpattya Antitumoral Centre were operated 8 patients, suffering the IVC leiomyosarcoma - 7 (87.5%) women and 1 (12.5%) man. Median of the patients' age have constituted 57 yrs old. For characterization of the affection localization in accordance to own views on the subject the classification of the IVC division into 7 segments was applied: infrarenal, іnterrenal, suprarenal, retrohepatic, іnfradiaphragmatic, supradiaphragmatic,іntracardial. Іntravasal localization of the tumor was observed in 3 (37.5%), extravasal - in 1 (12.5%), mixed - in 4 (50%) patients. In all the patients the open laparotomy approach was applied: in 1 (12.5%) patient median laparotomy was performed, and in 7 (87.5%) - bilateral subcostal laparotomy of a «Chevron» type. For the IVC alloprosthesis in 6 (75%) patients a politetrafluoroethylene prosthesis was applied, while in 2 (25%) - Gore-tex prosthesis of 18-22 mm in diameter. In 5 (62.5%) patients circular resection with the IVC alloprosthesis was done, in 2 (25%) - circular resection, the IVC alloprosthesis and іmplantation of right and left renal veins into the prosthesis, and in 1 (12.5%) - circular resection, alloprosthesis of IVC and implantation of left renal vein into prosthesis.

Results. The operation median duration have constituted 215 (160 - 320) min, while the average volume of the blood loss - 305 (250 - 500) ml. The Degree II postoperative complications in accordance to classification of Clavien-Dindo were registered in 2 (25%) patients. Pulmonary thromboembolism, venous thrombosis, thrombosis of prosthesis, as well as intraoperative or immediate postoperative lethality were not observed. In 7 (87.5%) patients a radical intervention was performed. In 3 (37.5%) patients a remote hepatic and pulmonary metastases have been developed, leading to their death in terms from 10 to 34 mo. General one-, two- and a three-ear survival have constituted 87.5, 75 and 62.5%, accordingly.

Conclusion. Surgical approach of a «Chevron» type and the staged dissection of IVC guarantees an adequate visualization of its іnfra-, іnter- and suprarenal segments. The «piggyback» procedure of hepatic mobilization and Pringle maneuver constitute necessary parts on the stage of dissection in retrohepatic, infradiaphragmatic and supradiaphragmatic segments of IVC. Radical tumoral excision with the IVC prosthesis and implantation, when needed, of renal or hepatic veins - is the only one possibility for improvement of the patients' quality of life in the IVC leiomyosarcoma.

Author Biographies

V. І. Rusin, Uzhgorod National University

Rusin Vasil I. - MD, DSci(Med), Professor
Hospital Surgery Department,
Uzhhorod National University
22 Peremohy Str., 88018, Uzhhorod, Ukraine
+38(0312) 61-35-70
kaf-surgery@uzhnu.edu.ua
https://orcid.org/0000-0001-5688-9951

S. O. Boiko, Uzhgorod National University

Boiko Serhii O. - MD, DSci(Med), Associate Professor,
Hospital Surgery Department,
Uzhhorod National University
22 Peremohy Str., 88018, Uzhhorod, Ukraine
+38(0312) 61-35-70
boiko.likar@gmail.com
https://orcid.org/0000-0002-8073-3030

V. V. Rusin, Uzhgorod National University

Rusin Vasil V. - MD, DSci(Med), Professor,
Hospital Surgery Department,
Uzhhorod National University
22 Peremohy Str., 88018, Uzhhorod, Ukraine
+38(0312) 61-35-70
kaf-surgery@uzhnu.edu.ua
https://orcid.org/0000-0003-4854-0228

F. V. Gorlenko, Uzhgorod National University

Gorlenko Fedir V. - MD, DSci(Med), Associate Professor,
Hospital Surgery Department,
Uzhhorod National University
2 Peremohy Str., 88018, Uzhhorod, Ukraine
+38(0312) 61-35-70
kaf-surgery@uzhnu.edu.ua
https://orcid.org/0000-0002-0496-2069

S. Sh. S. Boiko, Uzhgorod National University

Boiko Serhii Shandor S. - MD, PhD(Med) Student,
Hospital Surgery Department,
Uzhhorod National University
22 Peremohy Str., 88018, Uzhhorod, Ukraine
+38(0312) 61-35-70
123serg.boyko123@gmail.com
https://orcid.org/0000-0003-3016-6901

O. V. Syma, Uzhgorod National University

Syma Oleksandr V. - MD, PhD (Med) Student,
Hospital Surgery Department,
Uzhhorod National University
22 Peremohy Str., 88018, Uzhhorod, Ukraine
+38(0312) 61-35-70
alexclare200@gmail.com
https://orcid.org/0000-0002-4780-6322

References

Guerrero MA, Cross CA, Lin PH, Keane TE, Lumsden AB. Inferior vena cava reconstruction using fresh inferior vena cava allograft following caval resection for leiomyosarcoma: midterm results. J Vasc Surg. 2007 Jul 1;46(1):140-3. doi: 10.1016/j.jvs.2007.02.043. PMID: 17606132.

Laskin WB, Fanburg-Smith JC, Burke AP. Leiomyosarcoma of the inferior vena cava: clinicopathologic study of 40 cases. J Vasc Surg. 2010 Nov 1;52(5):1420. doi: 10.1097/PAS.0b013e3181ddf569. PMID: 20463568.

Tilkorn DJ, Hauser J, Ring A, Goertz O, Stricker I, Steinau HU et al. Leiomyosarcoma of intravascular origin-a rare tumor entity: clinical pathological study of twelve cases. World J Surg Onc. 2010 Dec;8(1):1-7. doi: 10.1186/1477-7819-8-103. PMID: 21092216.

Italiano A, Toulmonde M, Stoeckle E, Kind M, Kantor G, Coindre JM, et al. Clinical outcome of leiomyosarcomas of vascular origin: comparison with leiomyosarcomas of other origin. Ann Oncol. 2010 Sep 1;21(9):1915-21. doi: 10.1093/annonc/mdq039. PMID: 20167595.

Kieffer E, Alaoui M, Piette JC, Cacoub P, Chiche L. Leiomyosarcoma of the inferior vena cava: experience in 22 cases. Ann Surg. 2006 Aug;244(2):289. doi: 10.1097/01.sla.0000229964.71743.db. PMID: 16858193.

Mingoli A, Cavallaro A, Sapienza P, Di Marzo L, Feldhaus RJ, Cavallari N. International registry of inferior vena cava leiomyosarcoma: analysis of a world series on 218 patients. Anticancer Res. 1996 Sep 1;16(5B):3201-5. PMID: 8920790.

Hines OJ, Nelson S, Quinones-Baldrich WJ, Eilber FR. Leiomyosarcoma of the inferior vena cava: prognosis and comparison with leiomyosarcoma of other anatomic sites. Cancer. 1999 Mar 1;85(5):1077-83. PMID: 10091791.

Mingoli A, Feldhaus RJ, Cavallaro A, Stipa S. Leiomyosarcoma of the inferior vena cava: analysis and search of world literature on 141 patients and report of three new cases. J Vasc Surg. 1991 Nov;14(5):688-99. doi: 10.1067/mva.1991.30426. PMID: 1942380.

Wachtel H, Gupta M, Bartlett EK, Jackson BM, Kelz RR, Karakousis GC, et al. Outcomes after resection of leiomyosarcomas of the inferior vena cava: a pooled data analysis of 377 cases. Surg Oncol. 2015 Mar 1;24(1):21-7. doi: 10.1016/j.suronc.2014.10.007. PMID: 25433957.

Staley CJ, Valaitis J, Trippel OH, Franzblau SA. Leiomyosarcoma of the inferior vena cava. AJS. 1967 Feb 1;113(2):211-6. doi: 10.1016/0002-9610(67)90225-5. PMID: 6016721.

Dew J, Hansen K, Hammon J, McCoy T, Levine EA, Shen P. Leiomyosarcoma of the inferior vena cava: surgical management and clinical results. Am Surg. 2005 Jun;71(6):497-501. doi: 10.1177/000313480507100609. PMID: 16044929.

Hollenbeck ST, Grobmyer SR, Kent KC, Brennan MF. Surgical treatment and outcomes of patients with primary inferior vena cava leiomyosarcoma. J Am Coll Surg. 2003 Oct 1;197(4):575-9. doi: 10.1016/s1072-7515(03)00433-2. PMID: 14522326.https://doi.org/10.1016/s1072-7515(03)00433-2.

Armstrong PJ, Franklin DP. Pararenal vena cava leiomyosarcoma versus leiomyomatosis: difficult diagnosis. J Vasc Surg. 2002 Dec 1;36(6):1256-9. doi: 10.1067/mva.2002.129636. PMID: 12469059.

Ganeshalingam S, Rajeswaran G, Jones RL, Thway K, Moskovic E. Leiomyosarcomas of the inferior vena cava: diagnostic features on cross-sectional imaging. Clinical radiology. 2011 Jan 1;66(1):50-6. doi: 10.1016/j.crad.2010.08.004. PMID: 21147299.

Pantoja JL, Patel RP, Baril DT, Quinones-Baldrich W, Lawrence PF, Woo K. Caval Reconstruction with Undersized Ringed Graft after Resection of Inferior Vena Cava Leiomyosarcoma. Ann Vasc Surg. 2020 May;65:25-32. doi: 10.1016/j.avsg.2019.11.007. Epub 2019 Nov 9. PMID: 31715248; PMCID: PMC7210046.

Published
2021-11-28
How to Cite
RusinV. І., Boiko, S. O., Rusin, V. V., Gorlenko, F. V., Boiko, S. S. S., & Syma, O. V. (2021). Surgical treatment of the inferior vena cava (IVC) leiomyosarcoma. Klinicheskaia Khirurgiia, 88(9-10), 44-51. https://doi.org/10.26779/2522-1396.2021.9-10.44
Section
General Problems of Surgery