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Updated: Jan 9, 2026
Laparoscopic Anatomic S7+S8d Resection Preserving Inferior Right Hepatic Vein and S6 with Right Hepatic Vein Transection
Published on: December 30, 2025
Operative Considerations and Long-Term Outcomes after Resection of Primary Inferior Vena Cava Leiomyosarcomas with
Hamza Hanif1, Muhammad Ali Rana2, Lauren Marek1
1Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM.
Background:
To report the technical considerations and long-term outcomes of resection and vascular reconstruction of primary leiomyosarcoma (LMS) of the inferior vena cava (IVC).
Methods:
A single-center retrospective review of patients undergoing surgical resection for primary IVC LMS between 2012 and 2024. Patient demographics, operative details, and long-term outcomes were analyzed.
Results:
Nine patients (5 females, median age of 59 years (interquartile range [IQR] 50-71)) underwent resection. The median tumor size was 86 mm (IQR 83-170); with 78% (n = 7) located at the renocaval junction. The median length of IVC resected was 75 mm (IQR 28-108). All patients with circumferential resection underwent reconstruction with ringed polytetrafluoroethylene (PTFE) graft (n = 7, 78%), with contralateral renal vein reimplantation in 4 (44.4%). Two patients had partial resections with lateral IVC venorrhaphy in one and bovine patch venoplasty in the other 2. Intraoperative ultrasonography was used in all cases to define the extent of resection; preoperative venography with intravascular ultrasound (IVUS) performed in 2 patients to assess IVC patency, tumor extent, and renal vein involvement. Midline incision was used in 6 and Chevron incision in 3 more cephalad lesions. Major adverse events (MAE) occurred in 4 patients (44%), but no 30-day mortality was observed. The median hospital stay was 6 days (IQR 5-11). Over a median follow-up of 26 months (IQR 9-80), primary graft patency was 100%. Recurrence occurred in 4 patients (44%) at a median of 34 months from surgery. Adjuvant chemotherapy was given to 3 patients and radiation to 1. Overall survival at 3 and 5 years was 89% and 78%, respectively.
Conclusion:
Complete resection of IVC LMS with vascular reconstruction offers favorable long-term outcomes. Preoperative venography in selected patients, and intraoperative ultrasound in all patients should be considered.
