Surgical Technique, Morbidity, and Outcome of Primary Retroperitoneal Sarcoma Involving Inferior Vena Cava

Abstract

IVC resection is safe and well tolerated in RSTS patients. The need for vascular reconstruction has to be assessed according to preoperative imaging, intraoperative findings, and extent of resection. The specific role of banked venous homografts needs to be investigated in larger studies.

Sarcoma Resection With and Without Vascular Reconstruction: A Matched Case-Control Study

“…In particular, the optimal management of the IVC after resection is debatable, with some advocating ligation, 14,30 others selective, 12,31,32 and others routine reconstruction. 11,13,16,18 The rationale for the latter is based on the need to resect several venous collaterals for complete tumor removal, as well as the inability to predict which patients will tolerate IVC ligation without subsequent renal insufficiency or significant lower extremity edema.…”

“…When used for venous reconstructions, however, cryopreserved allografts have been shown to have decreased patency rates: in a series of 8 patients undergoing IVC replacement with cryopreserved allografts for retroperitoneal sarcoma, graft occlusion was observed in half of the patients (three late and asymptomatic and one early and symptomatic) likely due to the susceptibility of the pliable allograft to compression from abdominal viscera. 12 We have used cryopreserved allografts to reconstruct the IVC in two instances, one of which was complicated by early and symptomatic graft thrombosis. For this reason, we, and others, 11,18 favor IVC reconstruction with externally supported (ringed) polytetrafluoroethylene (PTFE) graft, in cases where there is no bowel contamination.…”

“…Over the last decade, several case series have established the feasibility and safety of en bloc vascular resection for sarcomas of the extremity, [3][4][5][6][7] retroperitoneum, [8][9][10] or specifically the inferior vena cava (IVC). [11][12][13][14][15][16][17][18] What remains unknown is whether these complex procedures are associated with a durable prolongation of survival that justifies their morbidity. Our institution has previously reported our findings with major blood vessel reconstruction on 14 sarcoma patients undergoing surgical resection.…”

Vaskularne intervencije kod tumora retroperitoneuma sa infiltracijom velikih krvnih sudova

“…Zbog osobina tumora kao što su kasno otkrivanje, veličina, histološki tip, u velikom broju slučajeva nije moguće potpuno uklanjanje tumora. U ovim okolnostima neophodno je reducirati tumorsko tkivo u što je moguće većoj mjeri kako bi se otklonili kompresivni efekti i smanjila endokrina aktivnost tumora [9]. Za sigurnu intraoperativnu procjenu operabilnosti i bezbjedno uklanjanje tumora u cjelini neophodno je široko operativno polje koje se najbolje postiže totalnom medijalnom laparotomijom.…”

Challenging Inferior Vena Cava Leiomyosarcoma: A Case Report and Literature Review of Management

“…If the vessel is patent and collaterals are not evident, reconstruction (usually with an interposition graft) should ideally be performed, especially if LMS involves trans-or suprarenal segments. If the vena cava is occluded prior to resection and/or clear collaterals are evidently developed, reconstruction does not need to be performed [20,21].…”