Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
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.

PubMed Disclaimer

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

References

    1. Mingoli A, Cavallaro A, Sapienza P, Di Marzo L, Feldhaus RJ, Cavallari N. International registry of inferior vena cava leiomyosarcoma: analysis of a world series on 218 patients. Anticancer Res. 1996;16:3201–3205. - PubMed
    1. Hilliard NJ, Heslin MJ, Castro CY. Leiomyosarcoma of the inferior vena cava: three case reports and review of the literature. Ann Diagn Pathol. 2005;9:259–266. - PubMed
    1. Fiore M, Colombo C, Locati P, Berselli M, Radaelli S, Morosi C, et al. Surgical technique, morbidity, and outcome of primary retroperitoneal sarcoma involving inferior vena cava. Ann Surg Oncol. 2012;19:511–518. - PubMed
    1. Kalkat MS, Abedin A, Rooney S, Doherty A, Faroqui M, Wallace M, et al. Renal tumours with cavo-atrial extension: surgical management and outcome. Interact Cardiovasc Thorac Surg. 2008;7:981–985. - PubMed
    1. Fan ST, Wei WI, Yong BH, Hui TWC, Chiu A, Lee PWH. Living Donor Liver Transplantation. 2nd edn. Raffles City: World Scientific; 2011. pp. 89–94.

Publication types