title: Resection of primary leiomyosarcoma of the inferior vena cava (IVC) with reconstruction: a case series and review of the literature.
abstract: BACKGROUND
  Leiomyosarcoma of the inferior vena cava (IVC) is a rare tumor which presents a unique surgical challenge. We present a series of six cases of leiomyosarcoma resection performed with IVC reconstruction.
  
  
  METHODS
  Retrospective chart review was performed for patients undergoing initial operative resection of primary leiomyosarcoma with IVC reconstruction, at a tertiary care center.
  
  
  RESULTS
  Between 2005-2013, six patients underwent resection with reconstruction. Half were female, and the mean age at presentation was 57 ± 15.4 years. Three patients required en bloc resection with adjacent organs. Three patients were resected on venovenous bypass, and one on cardiopulmonary bypass. Three underwent IVC patch repair (bovine pericardium, n = 2; saphenous vein, n = 1), and three had IVC reconstruction with graft (Dacron, n = 1; PTFE, n = 1; aortic homograft, n = 1). All achieved grossly negative margins. Median disease-free survival was 34 months (IQR 7-52 months), and median disease-specific survival was 51 months (IQR 20-108). Five year disease-free and disease-specific survival rates were 30% and 66.7%, respectively.
  
  
  CONCLUSIONS
  Leiomyosarcomas of the IVC present a technical challenge to the surgeon. Careful preoperative workup and a collaborative team consisting of experienced cardiac and vascular surgeons and surgical oncologists can allow for a safe and successful operation despite extensive tumor involvement.
authors.affiliation: Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Heather
authors.initials: H
authors.lastname: Wachtel
authors.forename: Benjamin M
authors.initials: BM
authors.lastname: Jackson
authors.forename: Edmund K
authors.initials: EK
authors.lastname: Bartlett
authors.forename: Giorgos C
authors.initials: GC
authors.lastname: Karakousis
authors.forename: Robert E
authors.initials: RE
authors.lastname: Roses
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Fraker
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007890:Leiomyosarcoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D015996:Survival Rate; D019043:Vascular Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*
keywords: inferior vena cava; leiomyosarcoma; reconstruction; retroperitoneal sarcoma