Surgical technique of removal of inferior vena cava leiomyosarcoma extending into the right atrium without deep hypothermic circulatory arrest.
BACKGROUND
Leiomyosarcoma of the inferior vena cava is a rare tumor with potential for significant morbidity and mortality. Surgical extirpiration remains the optimal treatment choice. A case of caval leiomyosarcoma with right atrial extension is presented with management techniques and literature review.


METHODS
A 54 year old woman with constitutional symptoms was found to have advanced caval leiomyosarcoma with atrial extension. Surgical excision was performed without deep hypothermic circulatory arrest (DHCA), including right nephrectomy, adrenalectomy, and en-bloc resection of the vena cava along with Gore-Tex interposition graft.


RESULTS
There were no operative complications. The patient was extubated on postoperative day one. Renal function remained normal. Final pathology was high grade leiomyosarcoma. Margins were negative. The patient is well at latest follow up.


CONCLUSIONS
Resection of extensive caval leiomyosarcoma allows the best chance of cure and is possible without DHCA. Perioperative planning and coordination and adherence to oncologic techniques is critical.
Division of Surgical Oncology, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, Florida 33139, USA.
Mohammed
M
Hassan
Gaetano
G
Ciancio
Samir P
SP
Shirodkar
Miguel B
MB
Del Mazo
Michael
M
Barron
Tomas A
TA
Salerno
Alan S
AS
Livingstone
D014408:Biomarkers, Tumor; D050792:Circulatory Arrest, Deep Hypothermia Induced; D017548:Echocardiography, Transesophageal; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007890:Leiomyosarcoma / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D019043:Vascular Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000601:surgery*
D014408:Biomarkers, Tumor