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. 2018 Dec;9(4):538-546.
doi: 10.1007/s13193-018-0796-9. Epub 2018 Jul 19.

Resection of the Inferior Vena Cava for Retroperitoneal Sarcoma: Six Cases and a Review of Literature

Joy Ghose  1 , Rahul Bhamre  1 , Nikhil Mehta  1 , Ashwin Desouza  1 , Shraddha Patkar  1 , Jayesh Dhareshwar  2 , Mahesh Goel  1 , Shailesh V Shrikhande  1
Affiliations

Resection of the Inferior Vena Cava for Retroperitoneal Sarcoma: Six Cases and a Review of Literature

Joy Ghose et al. Indian J Surg Oncol. 2018 Dec.

Abstract

Resection of the inferior vena cava (IVC) for malignancy is a technically demanding procedure. We present a series of six cases of resection of the IVC for retroperitoneal sarcomas, four of which were primary caval tumors. We outline the technical difficulties faced in these complex procedures and discuss the oncological outcomes of these rare tumors. We performed a retrospective review of six patients operated for retroperitoneal masses involving the inferior vena cava between April 2015 and July 2016 at our tertiary care institute. Six patients underwent resection of the IVC, three of which required a multivisceral resection. An artificial prosthesis was used to reconstruct the IVC in three patients, whereas two patients underwent primary repair of the vein wall. One patient did not require any reconstruction. Margins were microscopically positive in two out of six patients. All patients received radiotherapy, either in the neo-adjuvant or adjuvant setting. Two patients developed local recurrences with a median follow-up of 24.5 months. Resection of the IVC for extirpation of retroperitoneal sarcomas is a technically complex and difficult procedure. The availability of a multidisciplinary team of surgeons and state-of-the-art intensive care support is essential for good outcomes.

Keywords: Inferior vena cava; Leiomyosarcoma; Prosthetic graft; Reconstruction; Retroperitoneal sarcoma.

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Conflict of interest statement

The authors declare that they have no conflict of interest.All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. As this is a retrospective study, for this type of study, formal consent is not required. However, informed consent was obtained from all individual participants included in the study.Consent has been obtained from the patients/guardians for publication of relevant medical data and operative photographs without revelation of patient identity in this study.

Figures

Fig. 1
Fig. 1
CT scan showing pre- and post-operative images of a retroperitoneal mass involving the anterior wall of the inferior vena cava (IVC) with indistinct fat planes with the pancreas and duodenum and involvement of the ostium of the left renal vein
Fig. 2
Fig. 2
Steps of resection of a tumor involving the anterior wall of the inferior vena cava (a) with proximal and distal vascular control (b) with anastomosis of the left renal vein to the distal segment of the IVC (c) and outcomes of the inferior vena cava replaced with prosthetic grafts (d, e) and unreconstructed IVC (f)
See this image and copyright information in PMC

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