title: Role of surgery in the multimodal treatment of primary and recurrent leiomyosarcoma of the inferior vena cava.
abstract: BACKGROUND
  The optimal treatment of leiomyosarcoma (LMS) of the inferior vena cava (IVC) is still unclear, especially in the metastatic and/or recurrent setting. We herein evaluated the long-term outcome after aggressive management.
  
  
  METHODS
  Eleven patients underwent surgery for primary LMS of the IVC between 2000 and 2012. The clinical, pathological, and survival data were reviewed.
  
  
  RESULTS
  The IVC was managed by graft replacement in four cases, primary repair in four, and ligation in three. The R0 resection rate was 64%. The median follow-up was 60 months. Nine patients developed distant relapse, two of them concomitant local recurrence; no exclusive local recurrence was observed. The 3- and 5-year distant recurrence free survival were 30% and 10%, respectively. The 3- and 5-year overall-survival (OS) were 77.8%. The presence of residual disease after surgery (P = 0.024) and the time to recurrence (P = 0.033) were associated with the OS in a univariate analysis. The time to recurrence was related to the post-metastases survival (P = 0.032).
  
  
  CONCLUSIONS
  An adequate surgery minimizes the risk of local recurrence and remains the main treatment for primary LMS of the IVC. Nevertheless, the rate of distant metastases remains extremely high. An aggressive surgical policy may be of benefit to selected patients with metastatic disease. J. Surg. Oncol. 2016;114:44-49. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Surgical Oncology Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
authors.forename: Ferdinando Carlo Maria
authors.initials: FC
authors.lastname: Cananzi
authors.affiliation: Surgical Oncology Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Mussi
authors.affiliation: Vascular Surgery Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Bordoni
authors.affiliation: Department of Oncology and Hematology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Marrari
authors.affiliation: Department of Oncology and Hematology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: De Sanctis
authors.affiliation: Department of Pathology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
authors.forename: Piergiuseppe
authors.initials: P
authors.lastname: Colombo
authors.affiliation: Surgical Oncology Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Quagliuolo
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007890:Leiomyosarcoma / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008026:Ligation; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D058017:Vascular Grafting; D019043:Vascular Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*
keywords: inferior vena cava; leiomyosarcoma; metastases; sarcoma; surgery