Liver and Vena Cava En Bloc Resection for an Invasive Leiomyosarcoma Causing Budd–Chiari Syndrome, Under Veno-Venous Bypass and Liver Hypothermic Perfusion

Ravaioli, Matteo; Serenari, Matteo; Cescon, Matteo; Savini, Carlo; Cucchetti, Alessandro; Ercolani, Giorgio; Gaudio, Massimo Del; Casati, Alberto; Pinna, Antonio Daniele

doi:10.1245/s10434-016-5285-1

Cited by 10 publications

(5 citation statements)

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“…When the leiomyosarcoma affects heaptocaval region, Budd-Chiari syndrome could develop as clinical symptoms. [9,10] Due to the lack of specific tumor marker, some patients with early leiomyosarcoma could be presented with varicose vein of lower limb, deep venous thrombosis or ascites, therefore these conditions should be cautiously taken with further investigation with CT, MRI scan and ultrasonography required to rule out the possibility of leiomyosarcoma. [11] For patients who are tolerable to general anesthesia and with no remote organ metastasis, R0 surgical resection is vital important and provide long-term survival.…”

Section: Discussionmentioning

confidence: 99%

“…Oppression by giant tumor and / or returning obstacles of venous flow are the main causes of symptoms including back pain, abdominal lump, leg edema and sometimes hepatomegaly and ascites. When the leiomyosarcoma affects heaptocaval region, Budd-Chiari syndrome could develop as clinical symptoms [9,10] . Due to the lack of specific tumor marker, some patients with early leiomyosarcoma could be presented with varicose vein of lower limb, deep venous thrombosis or ascites, therefore these conditions should be cautiously taken with further investigation with CT, MRI scan and ultrasonography required to rule out the possibility of leiomyosarcoma [11] …”

Section: Discussionmentioning

confidence: 99%

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Surgical management strategy for leiomyosarcoma of Zone I-II inferior vena cava

Tulahong¹,

Tuxun²,

Yao³

et al. 2022

Medicine

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Objectives: Leiomyosarcoma of inferior vena cava (IVC) is a rare clinical entity with severe vascular involvement. Surgical management of leiomyosarcoma is still challenging.Methods: This a retrospective study of consecutive patients referred to our hospital from January 2017 to June 2019. Depending on the anatomical site of affected IVC, leiomyosarcomas were categorized into zone I-II. The clinical data including baseline information, surgical parameters, peri-operative management, short-and mid-term outcomes were observed.Results: Four patients with leiomyosarcoma of zone I-III underwent radical resection without intraoperative mortality. Prosthetic grafts were interpositioned in all patients to instruct vena cava. Renal vein reconstruction was perfumed in two patients due to involvement to renal veins. Median blood loss was 450 mL (200-600 mL), median operative time was 215 minutes (150-240 minutes). No Clavien-Dindo IIIa or higher complication was observed. No organ dysfunction and recurrence were observed with median follow-up of 25.5 months.Conclusions: Curative resection of zone I-II leiomyosarcoma is associated with longer survival in selected cases, en-bloc resection with complex vascular reconstruction could be considered.Abbreviations: CT = computed tomography, DFS = disease free survival, IVC = inferior vena cava, OS = overall survival.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Surgical management strategy for leiomyosarcoma of Zone I-II inferior vena cava

Tulahong¹,

Tuxun²,

Yao³

et al. 2022

Medicine

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“…Second, although our group has experience in liver resections within situ hepatic vein reconstruction with partial vascular occlusion, in this case we decided to opt for total vascular occlusion with placement of a veno-venous bypass because the patient needed both right hepatic vein and vena cava reconstruction. 3 , 4 For the right hepatic vein graft, a graft from the tissue bank was chosen to avoid the complications that can occur with an autologous graft. 5 …”

Section: Discussionmentioning

confidence: 99%

Extreme In Situ Liver Surgery Under Total Vascular Exclusion with Right Hepatic Vein and Inferior Vena Cava Grafts for an Intrahepatic Cholangiocarcinoma

López-López

Valles²,

Palenciano³

et al. 2022

Ann Surg Oncol

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In this multimedia article, we demonstrate an extreme in situ liver surgery under total vascular exclusion with right hepatic vein and inferior vena cava grafts for an intrahepatic cholangiocarcinoma in a centre with experience in highly complex hepatobiliary surgery and liver transplantation. This surgical approach after neoadjuvant chemotherapy provides an opportunity for surgical salvage in patients with large tumors invading the hepatocaval confluence. This patient was considered unresectable at another hospital and referred to our unit. We performed an accurate preoperative assessment with new generation 3D modelling to plan the type of vascular reconstruction that would allow adequate hepatic venous outflow and the volume of the future liver remnant sufficient to avoid postoperative liver failure. For hemodynamic management of the patient, we performed a total hepatic vascular exclusion with veno-venous bypass without intraoperative adverse events. We used a cryopreserved carotid artery graft after previously planning the most appropriate diameter and length for right hepatic vein reconstruction. The inferior vena cava was reconstructed with gore-tex graft. During the hospital stay there were no postoperative complications. The patient is free of disease. We conclude that patients with advanced malignant liver disease should always be referred to highly specialized liver surgery centers to assess the most appropriate oncological management and the possibility of surgical resectability.

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“…Liver resection has also been indicated due to the technical complexity and proximity of the tumour to the liver [ 12 ]. Tumour involvement of the hepatic vein confluence has a high likelihood of causing Budd-Chiari syndrome; as a result, it has been used as an indication for liver resection [ 13 ]. In the presented case, despite the lesion originating from the IVC, it appeared intrahepatic and encompassed the majority of the right liver, necessitating major liver resection for achieving an R0 resection.…”

Section: Discussionmentioning

confidence: 99%

Giant leiomyosarcoma of the inferior vena cava necessitating extended liver resection: A case report and review of the literature

Silverman

Pencovich

Mayer

et al. 2021

Journal of Surgical Case Reports

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Leiomyosarcoma of the inferior vena cava (IVC) is a rare malignant tumour of smooth muscle origin. It commonly presents with non-specific symptoms including abdominal pain, distention, and lower extremity edema. Surgical resection with macroscopically clear margins is the only potential curative treatment for the disease. Here we present the case of a previously healthy 38-year-old woman with a subacute one-month increase of a four-year slowly progressive right sided abdominal pain and back pain. Imaging revealed a 14.5x12x15cm mass in the right hepatic lobe causing mass effect on adjacent abdominal and retroperitoneal organs, and involving the retrohepatic IVC. En-bloc resection of the right hemi-liver, most of segment four, the caudate lobe, and approximately a 10 cm section of the retrohepatic IVC, along with IVC reconstruction, was performed. Histologic examination revealed the diagnosis of a high grade leiomyosarcoma.

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Liver and Vena Cava En Bloc Resection for an Invasive Leiomyosarcoma Causing Budd–Chiari Syndrome, Under Veno-Venous Bypass and Liver Hypothermic Perfusion

Abstract: Leiomyosarcoma of the IVC involving the hepatic veins can be treated with extended hepatectomy and removal of the IVC through extracorporeal circulation.

Cited by 10 publications

References 4 publications

Surgical management strategy for leiomyosarcoma of Zone I-II inferior vena cava

Surgical management strategy for leiomyosarcoma of Zone I-II inferior vena cava

Extreme In Situ Liver Surgery Under Total Vascular Exclusion with Right Hepatic Vein and Inferior Vena Cava Grafts for an Intrahepatic Cholangiocarcinoma

Giant leiomyosarcoma of the inferior vena cava necessitating extended liver resection: A case report and review of the literature

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