title: Leiomyosarcoma of the inferior vena cava: experience in 22 cases.
abstract: From 1979 to 2004, 22 patients were seen with leiomyosarcomas of the inferior vena cava (IVC). Twenty were treated surgically. Involvement of the IVC included the infrarenal segment in 3 cases, the suprarenal and/or retrohepatic segment in 13, and the suprahepatic segment in 4. Nineteen patients underwent wide tumor resection followed by ligation of the IVC in 5 cases, replacement with a PTFE prosthesis in 13, and cavoplasty in 1. An intracardiac tumor extension was resected during hypothermic circulatory arrest in 1 patient. Vascular exclusion of the liver was used in 5 cases and simple clamping of the IVC in 13 cases. There were 1 intraoperative death due to cardiac failure and 3 postoperative deaths due to multiple organ failure, liver failure, and duodenal fistula after treatment of a bleeding ulcer. Fifteen of the 16 surviving patients underwent adjuvant chemotherapy associated with radiation therapy in 4 cases. One patient was lost from follow-up at 10 months. Four patients including one with metastasis are still alive with a mean follow-up of 18.3 months. Eleven patients died after a mean follow-up period of 43.7 months due to local recurrence and/or distant metastasis in 9 cases and complications of chemotherapy in 2. The 3- and 5-year mean actuarial survival rates in patients who underwent resection were 52.0% and 34.8%, respectively. Leiomyosarcoma of the IVC is a serious disease. Although surgical resection combined with chemotherapy is usually not curative, it can achieve reasonably long-term survival. We recommend aggressive operative management using the latest vascular surgery and oncology techniques.
authors.affiliation: Department of Vascular Surgery, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. edouard.kieffer@psl.aphp.fr
authors.forename: Edouard
authors.initials: E
authors.lastname: Kieffer
authors.forename: Mustapha
authors.initials: M
authors.lastname: Alaoui
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Piette
authors.forename: Patrice
authors.initials: P
authors.lastname: Cacoub
authors.forename: Laurent
authors.initials: L
authors.lastname: Chiche
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation; D002423:Cause of Death; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006324:Heart Arrest, Induced; D006338:Heart Neoplasms / Q000601:surgery; D006801:Humans; D007036:Hypothermia, Induced; D007431:Intraoperative Complications; D007890:Leiomyosarcoma / Q000556:secondary / Q000601:surgery*; D008026:Ligation; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate; D019043:Vascular Neoplasms / Q000601:surgery*; D014682:Vena Cava, Inferior / Q000601:surgery*
chemical_list: D011138:Polytetrafluoroethylene