title: Surgical challenges in the treatment of leiomyosarcoma of the inferior vena cava: analysis of two cases and brief review of the literature.
abstract: BACKGROUND
  Leiomyosarcoma of the inferior vena cava (IVC) is a rare tumor of mesenchymal origin. Optimal treatment should include complete resection of the malignant lesion with preservation of venous return. We present our experience from two patients treated in our hospital in the last 3 years.
  
  
  RESULTS
  The first case is that of a 54-year-old woman, with a 9 cm a primary IVC leiomyosarcoma extending from the level of the right renal vein to the common iliac veins. The patient underwent radical tumor resection and reconstruction of the IVC with a polytetrafluoroethylene patch. She received adjuvant chemotherapy and is free of recurrence almost 3 years after surgery. The second case is that of a 56-year-old woman presenting with back pain due to an 8-cm retroperitoneal mass in close proximity to the right renal vein. She underwent exploratory laparotomy, where initially the effort of en bloc resection of the mass failed. Eventually, partial resection of the IVC was performed and the defect was primarily repaired. Pathological examination confirmed primary leiomyosarcoma of the IVC. She received adjuvant chemotherapy, but was referred to our hospital with local recurrence 6 months after the operation and is suffering from disseminated abdominal disease almost a year postsurgery.
  
  
  CONCLUSIONS
  Radical surgical en bloc resection is the mainstay of treatment for IVC leiomyosarcomas. Extensive vascular reconstruction techniques may be necessary to restore adequate venous return to the IVC after tumor resection, and combination with adjuvant chemoradiotherapy has been shown to prolong disease-free survival rates.
authors.affiliation: 2nd Department of Surgery, Aretaieion Hospital, University of Athens Medical School, Athens, Greece. mkyriazi@otenet.gr
authors.forename: Maria A
authors.initials: MA
authors.lastname: Kyriazi
authors.forename: Vaia K
authors.initials: VK
authors.lastname: Stafyla
authors.forename: Ioannis
authors.initials: I
authors.lastname: Chatzinikolaou
authors.forename: Andreas
authors.initials: A
authors.lastname: Koureas
authors.forename: Achilleus
authors.initials: A
authors.lastname: Chatziioannou
authors.forename: Agathi
authors.initials: A
authors.lastname: Kondi-Paphiti
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Arkadopoulos
authors.forename: Vassilios
authors.initials: V
authors.lastname: Smyrniotis
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D001416:Back Pain / Q000209:etiology; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D007890:Leiomyosarcoma / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D019043:Vascular Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D014656:Vascular Surgical Procedures; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*