Surgical treatment of tumors involving the inferior vena cava. Personal experience

Background Leiomyosarcoma of the inferior vena cava (IVC) is a rare tumor, frequently is asymptomatic. Surgical treatment is complex. We reviewed our experience in order to underline the peculiar replacement modalities of the vena cava or other vessels after complete tumor resection. Methods We treated twelve patients with IVC leiomyosarcomas during last 20 years, 6 females and 6 males aged between 38 and 72 years. All patients apparently were free of distant metastases. Tumor location, graft patency, long-term survival and tumor recurrence were remarked. In 8 patients, tumors arose from the IVC and in 2 cases the intracaval mass reached the right atrium; in 4 patients tumors arose from the femoro-iliac axis. Surgical approach was sternolaparotomy in 5 cases, median xipho-pubic access in 7 cases. In 2 cases it was necessary to use the Extracorporeal Circulation (ECC). En bloc resection of the tumor was always performed. The IVC was directly sutured in 2 patients and patched in 4, in 2 patients the reconstruction was not necessary. In the remaining cases the IVC was replaced. Four patients had an additional arteriovenous fistula. One patient was submitted to bifurcated Dacron graft replacement of the aortic carrefour involved by tumor. Results Two patients died postoperatively. One patient presented late stenosis of PTFE graft, treated by stent. Mean follow-up was 35 months. At 4 years 51% of survival and 63% free of recurrence. Conclusion Leiomyosarcoma of the IVC is an uncommon tumor that presents with non-specific symptoms. In absence of distant malignancy an aggressive approach can determine a late survival free of recurrence.