title: Technical considerations for radical resection of a primary leiomyosarcoma of the vena cava.
abstract: BACKGROUND
  Radical resection provides the best hope for cure in leiomyosarcoma of the inferior vena cava (IVC). Multi-visceral resection is often indicated by extensive tumour involvement. This report describes the technical challenges encountered during resection of a retrohepatic IVC leiomyosarcoma.
  
  
  METHODS
  Computed tomography showed an IVC leiomyosarcoma measuring 7.8 × 10.0 × 19.3 cm in a 41-year-old patient. The tumour reached the confluence of the hepatic veins, displacing the caudate lobe anteriorly and extending towards the IVC bifurcation inferiorly. En bloc resection of the IVC tumour with a right hepatic and caudate lobectomy, and a right nephrectomy was performed.
  
  
  RESULTS
  Subsequent to a Cattel manoeuvre, the operative procedures carried out can be broadly categorized in four major steps: (i) mobilization of the infrahepatic IVC and tumour; (ii) mobilization of the suprahepatic IVC from diaphragmatic attachments; (iii) right hepatectomy with complete caudate lobe resection, and (iv) en bloc resection of the IVC tumour. This approach allowed the entire length of tumour-bearing IVC to be freed from the retroperitoneum and avoided the risk for iatrogenic tumour rupture during dissection at the retrohepatic IVC. Reconstruction of the IVC was not performed in the presence of venous collaterals.
  
  
  CONCLUSIONS
  Experience in liver resection and transplantation, and appreciation of the hepatocaval anatomy facilitate the safe and radical resection of retrohepatic IVC leiomyosarcoma.
authors: Department of Surgery, University of Hong Kong, Queen Mary Hospital, China. acchan@hku.hk
authors: Albert C Y
authors: AC
authors: Chan
authors: See Ching
authors: SC
authors: Chan
authors: Ming Kwong
authors: MK
authors: Yiu
authors: Kwan Lun
authors: KL
authors: Ho
authors: Edmond M H
authors: EM
authors: Wong
authors: Chung Mau
authors: CM
authors: Lo
mesh_terms: D000328:Adult; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007890:Leiomyosarcoma / Q000473:pathology / Q000601:surgery*; D009392:Nephrectomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D019043:Vascular Neoplasms / Q000473:pathology / Q000601:surgery*; D014656:Vascular Surgical Procedures; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*