Surgical outcomes of patients with inferior vena cava leiomyosarcoma

Abstract

Introduction: Primary vascular leiomyosarcomas are incredibly rare and have a poor prognosis. The purpose of this study was to analyze the surgical outcomes of patients with primary inferior vena cava (IVC) leiomyosarcoma.

Methods: We performed a retrospective review of IVC leiomyosarcoma resections performed at a single tertiary care hospital from 2014 to 2023. A total of 13 cases were analyzed, including 10 women and 3 men. The presenting symptoms, tumor characteristics, operative management, postoperative complications, and survival rates were assessed for each patient.

Results: The median patient age was 59 years (quartile [Q]1, 52 years; Q3, 68 years). The median tumor size was 7.0 cm (Q1, 6 cm; Q3, 12 cm). The median mitotic rate was 6 per 10 high-power fields (Q1, 2.5; Q3, 15.5). All 13 patients underwent grossly negative tumor resection, with 9 (69%) having microscopically negative margins (R0). No patient had lymph node involvement. The IVCs were managed with ligation in four patients for tumors already occluding the IVC and bovine pericardial patch angioplasty in seven patients or primary repair in two patients for patent IVCs. Concomitant right nephrectomy was performed in seven patients. Left renal vein ligation was performed in three patients, but no left nephrectomies were performed. Significant postoperative complications included one patient with lower extremity compartment syndrome, two patients with severe leg swelling, and one patient with arm swelling. The 30-day mortality rate was zero. Using the Kaplan-Meier product limit method, disease-specific survival was estimated to be 93%.

Conclusions: Surgical resection is a feasible and effective oncologic treatment option for patients with IVC leiomyosarcoma. The IVC can be safely managed by ligation, primary repair, or patch angioplasty, depending on the prior patency of the IVC.

Keywords: IVC leiomyosarcoma; IVC ligation; IVC patch angioplasty; IVC primary repair; Perirenal tumors; Renal vein ligation; Retroperitoneal sarcoma.

Fig 1

Preoperative and postoperative computed tomography (CT) scan of a patient with inferior vena cava (IVC) leiomyosarcoma managed with patch angioplasty.

Fig 2

Postoperative computed tomography (CT) scan of a patient with inferior vena cava (IVC) leiomyosarcoma managed with right nephrectomy, suprarenal IVC ligation, and left renal venous drainage via the adrenal, gonadal, and lumbar veins.

Fig 3

Inferior vena cava (IVC) of a patient with IVC leiomyosarcoma after patch angioplasty.