Operative Considerations and Long-Term Outcomes after Resection of Primary Inferior Vena Cava Leiomyosarcomas with...

Area of Science:

• Vascular Surgery
• Surgical Oncology
• Medical Imaging

Background:

• Primary leiomyosarcoma (LMS) of the inferior vena cava (IVC) is a rare malignancy.
• Surgical resection with vascular reconstruction is a primary treatment modality.
• Technical challenges and long-term outcomes require detailed reporting.

Purpose of the Study:

• To detail the technical considerations for surgical resection of primary IVC LMS.
• To evaluate the long-term outcomes following resection and vascular reconstruction.
• To assess the role of preoperative and intraoperative imaging in managing IVC LMS.

Main Methods:

• Single-center retrospective review of patients undergoing resection for primary IVC LMS (2012-2024).
• Analysis of patient demographics, operative details, and long-term outcomes.
• Utilized intraoperative ultrasonography and preoperative venography with intravascular ultrasound (IVUS) for assessment.

Main Results:

• Nine patients (median age 59) underwent resection; 78% had tumors at the renocaval junction.
• 78% required circumferential resection and PTFE graft reconstruction; 44.4% had renal vein reimplantation.
• 44% experienced major adverse events, but no 30-day mortality. Median follow-up was 26 months; 100% primary graft patency.
• 44% recurrence rate at a median of 34 months. 3- and 5-year overall survival rates were 89% and 78%.

Conclusions:

• Complete resection of IVC LMS with vascular reconstruction yields favorable long-term survival.
• Intraoperative ultrasound is essential for all patients.
• Preoperative venography should be considered for selected cases to optimize surgical planning.