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Case Reports
. 2012 Aug;14(8):565-8.
doi: 10.1111/j.1477-2574.2012.00485.x. Epub 2012 May 20.

Technical considerations for radical resection of a primary leiomyosarcoma of the vena cava

Albert C Y Chan  1 , See Ching Chan, Ming Kwong Yiu, Kwan Lun Ho, Edmond M H Wong, Chung Mau Lo
Affiliations
Case Reports

Technical considerations for radical resection of a primary leiomyosarcoma of the vena cava

Albert C Y Chan et al. HPB (Oxford). 2012 Aug.

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.

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Figures

Figure 1
Figure 1
Computed tomography images of the inferior vena cava leiomyosarcoma, showing (a) a coronal view and (b) a cross-sectional view. The dashed red line denotes the hepatic transection plane
Figure 2
Figure 2
Exposure of the inferior vena cava and tumour after kocherization of the duodenum
Figure 3
Figure 3
Right hepatectomy with complete caudate lobe resection. IVC, inferior vena cava
Figure 4
Figure 4
Graphic illustration of inferior vena cava (IVC) tumour resection. RHV, right hepatic vein; MHV, middle hepatic vein; LHV, left hepatic vein
Figure 5
Figure 5
Macroscopic appearance of the inferior vena cava leiomyosarcoma
See this image and copyright information in PMC

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