title: Surgical technique, morbidity, and outcome of primary retroperitoneal sarcoma involving inferior vena cava.
abstract: BACKGROUND
  Retroperitoneal sarcomas (RSTS) involving inferior vena cava (IVC) are rare entities. Vascular resection and reconstruction represent a technical challenge. The aim of the study was to review a monoinstitutional series of IVC resections for RSTS (mainly IVC leiomyosarcoma), focusing on the type of vascular replacement, morbidity, and oncologic outcome.
  
  
  METHODS
  From January 2004 to January 2011, 15 patients (7 male, 8 female) surgically treated for RSTS involving primarily or secondarily IVC were included.
  
  
  RESULTS
  A total of ten patients had IVC replacement and one had partial IVC resection (anterior wall). En bloc organ resection was performed in 14 patients (93%). Major venous reconstructions were performed using PTFE prosthesis (2) or banked venous homografts (8). In four patients IVC reconstruction was not necessary because of the presence of efficient collaterals. Early clinically relevant complications (grade ≥3) were detected in one patient (7%) (symptomatic graft thrombosis). No reoperations were needed. No late relevant complications (grade ≥3) were observed. Overall graft patency was 60%. At a median follow up of 31.6 months, local recurrence, distant metastases, and survival rate were 20, 26, and 80%, respectively. Complete tumor resection was achieved in all patients.
  
  
  CONCLUSIONS
  IVC resection is safe and well tolerated in RSTS patients. The need for vascular reconstruction has to be assessed according to preoperative imaging, intraoperative findings, and extent of resection. The specific role of banked venous homografts needs to be investigated in larger studies.
authors.affiliation: Department of Surgery, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy. marco.fiore@istitutotumori.mi.it
authors.forename: Marco
authors.initials: M
authors.lastname: Fiore
authors.forename: Chiara
authors.initials: C
authors.lastname: Colombo
authors.forename: Piermarco
authors.initials: P
authors.lastname: Locati
authors.forename: Mattia
authors.initials: M
authors.lastname: Berselli
authors.forename: Stefano
authors.initials: S
authors.lastname: Radaelli
authors.forename: Carlo
authors.initials: C
authors.lastname: Morosi
authors.forename: Paolo G
authors.initials: PG
authors.lastname: Casali
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gronchi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications; D012186:Retroperitoneal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome; D019043:Vascular Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery; D014682:Vena Cava, Inferior / Q000601:surgery*