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Case Reports
. 2009 Jan 6:7:3.
doi: 10.1186/1477-7819-7-3.

Pancreatic and multiorgan resection with inferior vena cava reconstruction for retroperitoneal leiomyosarcoma

John A Stauffer  1 , G Peter Fakhre, Marjorie K Dougherty, Raouf E Nakhleh, William J Maples, Justin H Nguyen
Affiliations
Case Reports

Pancreatic and multiorgan resection with inferior vena cava reconstruction for retroperitoneal leiomyosarcoma

John A Stauffer et al. World J Surg Oncol. .

Abstract

Background: Inferior vena cava (IVC) leiomyosarcoma is a rare tumor of smooth muscle origin. It is often large by the time of diagnosis and may involve adjacent organs. A margin-free resection may be curative, but the resection must involve the tumor en bloc with the affected segment of vena cava and locally involved organs. IVC resection often requires vascular reconstruction, which can be done with prosthetic graft.

Case presentation: We describe a 39-year-old man with an IVC leiomyosarcoma that involved the adrenal gland, distal pancreas, and blood supply to the spleen and left kidney. Tumor excision involved en bloc resection of all involved organs with reimplantation of the right renal vein and reconstruction of the IVC with a polytetrafluoroethylene graft. The patient recovered without renal insufficiency, graft infection, or other complications. Follow-up abdominal imaging at 1 year showed a patent IVC graft and no locally recurrent tumor. Prosthetic graft provides a sufficient diameter and length for replacement conduit in extensive resection of IVC leiomyosarcoma.

Conclusion: To our knowledge, this is the first case of resection of an IVC sarcoma with prosthetic graft reconstruction in combination with pancreatic resection. Aggressive surgical resection including vascular reconstruction is warranted for select IVC tumors to achieve a potentially curative outcome.

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Figures

Figure 1
Figure 1
a, Magnetic resonance imaging shows the tumor (large asterisk) lying to the left of the superior mesenteric artery (SMA), involving the distal pancreas anteriorly, the superior pole of the left kidney posteriorly, and extending into the inferior vena cava (IVC) (small asterisk). b, The tumor (large asterisk) involves and encases the left renal vein and extends into the IVC. SMA indicates superior mesenteric artery.
Figure 2
Figure 2
The interposition polytetrafluoroethylene graft (asterisk) was anastomosed superiorly to the inferior vena cava (IVC) just below the liver, and inferior to the infrarenal IVC, the right renal vein (RRV) was reimplanted into the native IVC.
Figure 3
Figure 3
a, Specimen contained tumor mass, left kidney, left adrenal gland, spleen, and distal pancreas. b, Leiomyosarcoma is seen in the lumen of the vena cava. The vena cava wall is on the right. c, Tumor fills the bottom of the picture pushing into the adrenal gland seen at the top of the picture. d, Tumor has replaced a portion of the pancreas. A pancreatic islet complex is marked (hematoxylin and eosin, original magnification × 20).
Figure 4
Figure 4
One-year follow-up magnetic resonance image shows patent polytetrafluoroethylene graft (asterisk) and no local tumor recurrence.
See this image and copyright information in PMC

References

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