Surgical management of vena cava sarcoma: a technical challenge

Area of Science:

• Oncology
• Vascular Surgery
• Surgical Pathology

Background:

• Inferior vena cava (IVC) sarcomas are rare, aggressive malignancies with limited treatment options and poor prognoses.
• Surgical resection is the only potentially curative modality, yet it presents significant challenges due to tumor extent and potential complications.

Purpose of the Study:

• To present a case study of a locally advanced inferior vena cava leiomyosarcoma.
• To illustrate the multidisciplinary management approach, including neoadjuvant therapy and complex surgical resection with vascular reconstruction.

Main Methods:

• Diagnosis of retroperitoneal mass infiltrating the IVC, liver, and diaphragm via biopsy, confirming leiomyosarcoma.
• Neoadjuvant chemotherapy and radiotherapy followed by radical surgical resection of the tumor and involved organs.
• Inferior vena cava reconstruction using a cadaver vein graft.

Main Results:

• Successful surgical resection of a locally advanced IVC leiomyosarcoma involving adjacent organs.
• Vascular reconstruction achieved using a cadaver vein graft.
• Demonstration of a feasible, albeit challenging, treatment pathway for complex IVC sarcomas.

Conclusions:

• Surgical resection remains the cornerstone of potentially curative treatment for IVC sarcomas, despite their aggressive nature.
• Multidisciplinary neoadjuvant therapy followed by radical surgery and reconstruction can be effective.
• Long-term surveillance is essential due to the high risk of recurrence in IVC sarcoma patients.