Retrohepatic Caval Leiomyosarcoma Antesitum Resection: A Case Report and a Review of Literature

Das, S. Aurobindo P.; Paleela, Pardha S.; Kuppuswamy, Madhan Kumar; Venugopal, Balaji; Krishnan, Elankumaran

doi:10.1016/j.jceh.2021.01.002

Cited by 2 publications

(2 citation statements)

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“…The main treatment of IVC leiomyosarcoma is surgical; however, resection and reconstruction techniques vary and are dependent on several factors ( 10 ). Surgical techniques include excision of the IVC, explantation of the liver with resection of the cava, resection of the cava utilizing total vascular exclusion with hypothermia, and liver transplantation with or without reconstruction of the IVC ( 2 , 8 , 11 , 12 ). If resection is performed, reconstruction of the IVC may or may not be necessary, depending on the degree and duration of obstruction and the presence of venous collaterals ( 2 , 13 ).…”

Section: Discussionmentioning

confidence: 99%

“…Retro-hepatic inferior vena cava (IVC) leiomyosarcoma is a rare condition with special anatomic considerations that make resection and reconstruction difficult. Case reports detailing successful tumor removal are few (in the hundreds), speaking to the condition’s rarity and the expertise required to perform a successful resection ( 1 , 2 ). The techniques of resection described in the literature include: En-bloc liver and IVC resection.…”

Section: Introductionmentioning

confidence: 99%

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Case report: Surgical resection of a retro-hepatic leiomyosarcoma involving atrial reconstruction, cardiopulmonary bypass, ex vivo tumor resection, and liver re-implantation

Sharma

Okakpu²,

Murthy³

et al. 2022

Front. Surg.

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IntroductionLeiomyosarcomas (LMS) involving the inferior vena cava (IVC) is a clinically rare entity, accounting for approximately 0.5% of all adult sarcomas.Case presentationA 67-year-old male presented to the emergency department with mild back and lower abdominal pain. During the workup, a computed tomography scan without contrast showed an area of decreased attenuation within the liver adjacent to the intrahepatic IVC. Magnetic resonance imaging confirmed the involvement of the retro-hepatic IVC; biopsy confirmed the diagnosis of LMS. Given the location of the involvement of the retro-hepatic IVC, liver explantation was deemed necessary for adequate tumor resection. The superior extension of the tumor toward the heart necessitated Cardio-Pulmonary (CPB). The patient successfully underwent a complex surgical procedure involving liver explantation with ex vivo back-table resection of the retro-hepatic LMS, replacement of the retro-hepatic vena cava with a ringed Gore-Tex graft, liver re-implantation, and hepatic vein-atrial reconstruction under cardiopulmonary bypass. There were no intraoperative or post-op complications.DiscussionThe role of vascular reconstruction of the IVC varies depending on the level and extent of the tumor, with options ranging from primary repair, ligation, or reconstruction dictated. Surgical resection with negative margins remains the treatment of choice due to the lack of efficacy of adjuvant therapies. Importantly, liver explantation offers a chance for complete surgical resection and reconstruction. Similarly, the complex nature of the tumor necessitated a pioneering approach involving direct hepato-atrial venous anastomosis.ConclusionTo the best of our knowledge, this is the first reported case in which the hepatic veins were anastomosed directly to the right atrium while also replacing the native vena cava with a separate graft.

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