Prosthetic Replacement of the Infrahepatic Inferior Vena Cava for Leiomyosarcoma

Illuminati, Giulio; Caliò, Francesco G.; D’Urso, Antonio; Giacobbi, Daniela; Papaspyropoulos, Vassilios; Ceccanei, Gianluca

doi:10.1001/archsurg.141.9.919

Cited by 93 publications

(66 citation statements)

References 26 publications

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“…If negative margins can be achieved, extended venous resection does not influence local recurrence rate or long-term outcome [21] . Radical resection of the tumor en bloc with the affected segment of the vena cava has been shown to be a feasible option with improved survival in multiple studies [17][18][19][20]22,23] . However, such patients have a poor prognosis and over half of them who undergo radical resection develop tumor recurrence; the 5-year survival rate ranges between 31% and 62% [24] .…”

Section: Discussionmentioning

confidence: 99%

“…Kieffer et al [19] used a proximal pressure reading of 30 mm Hg or more in the IVC as an indication for caval reconstruction and found reconstruction to be necessary in most cases. PTFE is the most commonly used prosthetic material and has been shown to be a suitable replacement for the IVC with excellent long-term patency [19,20,23,27,28] . Infection and graft thrombosis are the 2 major complications of this type of reconstruction but both are rare.…”

Section: Discussionmentioning

confidence: 99%

“…Graft thrombosis may or may not have any clinical importance and methods used to decrease its incidence include the use of ring-reinforced PTFE to prevent compression, short-term anticoagulation and placement of an arterio-venous fistula to augment flow [19] . PTFE graft infection after IVC replacement has been shown to be a rare occurrence in several large series [19,20,23,27] . The treatment is usually conservative but in some cases the graft must be removed.…”

Section: Discussionmentioning

confidence: 99%

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Resection and reconstruction of the inferior vena cava for neoplasms

Vladov¹,

Mihaylov²,

Belev³

et al. 2012

WJGS

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AIM:To evaluate the results of an aggressive surgical approach of resection and reconstruction of the inferior vena cava (IVC). METHODS:The approach to caval resection depends on the extent and location of tumor involvement. The supra-and infra-hepatic portion of the IVC was dissected and taped. Left and right renal veins were also taped to control the bleeding. In 12 of the cases with partial tangential resection of the IVC, the flow was reduced to less than 40% so that the vein was primarily closed with a running suture. In 3 of the cases, the lumen of the vein was significantly reduced, requiring the use of a polytetrafluoroethylene (PTFE) patch. In 2 of the cases with segmental resection of the IVC, a PTFE prosthesis was used and in 1 case, the IVC was resected without reconstruction due to shunting the blood through the azygos and hemiazygos veins. RESULTS:The mean operation time was 266 min (230-310 min) with an average intraoperative blood loss of 300 mL (200-2000 mL). The patients stayed in intensive care unit for 1.8 d (1-3 d). Mean hospital stay was 9 d (7-15 d). Twelve patients (66.7%) had no complications and 6 patients (33.3%) had the following complications: acute bleeding in 2 patients; bile leak in 2 patients; intra abdominal abscess in 1 patient; pulmonary embolism in 2 patients; and partial thrombosis of the patch in 1 patient. General complications such as pneumonia, pleural effusion and cardiac arrest were observed in the same group of patients. In all but 1 case, the complications were transient and successfully controlled. The mortality rate was 11.1% (n = 2). One patient died due to cardiac arrest and pulmonary embolism in the operation room and the second one died 2 d after surgery due to coagulopathy. With a median follow-up of 24 mo, 5 (27.8%) patients died of tumor recurrence and 11 (61.1%) are still alive, but three of them have a recurrence on computed tomography. CONCLUSION:There are a variety of options for reconstruction after resection of the IVC that offers a higher resectable rate and better prognosis in selected cases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Resection and reconstruction of the inferior vena cava for neoplasms

Vladov¹,

Mihaylov²,

Belev³

et al. 2012

WJGS

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“…Leiomyosarkome werden meist spät erkannt und haben bei Diagnosestellung häufig bereits eine erhebliche Größe erreicht [5]. Die Symptome sind oft unspezifisch, mit Schmerzen, Leistungsminderung und Gewichtsverlust [1,4,6,10].…”

Section: Symptomeunclassified

“…Je nach Lokalisation und bestehenden Kollateralen ist ein prothetischer Gefäßersatz erforderlich [5,6]. Tumoren im Segment II der V. cava haben eine etwas bessere Prognose [3,9].…”

Section: Therapie Und Prognoseunclassified

Seltene Differenzialdiagnose bei Verdacht auf Lebertumor

et al. 2009

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This case report describes a 77-year old woman with a leiomyosarcoma of subhepatic inferior caval vein. The presented symptom was unspecific abdominal pain. Ultrasound and CT suggested a primary liver tumor. MRI revealed retroperitoneal location of the neoplasm. The tumor was resected completely and ICV was replaced by a PTF-graft. Vascular leiomyosarcoma is a rare tumor entity, which often is diagnosed in advanced stage. Depending on location it can be mistaken for neoplasms of other organs.

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Authors' reply: interposition graft with polytetrafluoroethylene for mesenteric and portal vein reconstruction after pancreaticoduodenectomy (Br J Surg 2009; 96: 247–252)

Nguyen

2009

British Journal of Surgery

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Prosthetic Replacement of the Infrahepatic Inferior Vena Cava for Leiomyosarcoma

Cited by 93 publications

References 26 publications

Resection and reconstruction of the inferior vena cava for neoplasms

Resection and reconstruction of the inferior vena cava for neoplasms

Seltene Differenzialdiagnose bei Verdacht auf Lebertumor

Authors' reply: interposition graft with polytetrafluoroethylene for mesenteric and portal vein reconstruction after pancreaticoduodenectomy (Br J Surg 2009; 96: 247–252)

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