Inferior Vena Cava Leiomyosarcoma: What Method of Reconstruction for Which Type of Resection?
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SCIENTIFIC REVIEW
Inferior Vena Cava Leiomyosarcoma: What Method of Reconstruction for Which Type of Resection? Elodie Gaignard1,2 • Damien Bergeat1,2,3 • Fabien Robin1,2,3 • Lisa Corbie`re1,2 Michel Rayar1,2 • Bernard Meunier1,2
•
Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Inferior vena cava leiomyosarcoma (IVCL) is a rare tumor with a poor prognosis, and its surgical resection remains a challenge. To date, surgery is the only potentially curative treatment for IVCL with a 5-year survival rate of 55%. The main challenge is to combine oncological surgery with clear margins and vascular reconstruction of the inferior vena cava (IVC). In this review, we discuss the different approaches to vascular reconstruction after IVCL resection, using a prosthetic or autologous patch, direct suture or simple ligation without IVC reconstruction. The reconstruction of IVC depends of tumor location and its extension. We recommend no reconstruction if venous collaterality is well-established. When vascular reconstruction is required, we prefer prosthetic PTFE graft. These patients should be referred to high-volume centers with a multidisciplinary team of sarcoma surgeons with cardiothoracic, vascular and hepatic specialties.
Abbreviations LMS Leiomyosarcoma STS Soft tissue sarcoma IVC Inferior vena cava IVCL Inferior vena cava leiomyosarcoma ESMO European Society of Medical Oncology MRI Magnetic resonance imaging CT scan Computed tomography scan RPS Retroperitoneal sarcoma FNCLCC Fe´de´ration Nationale des Centres de Lutte Contre le Cancer RA Right atrium PTFE Polytetrafluoroethylene
& Elodie Gaignard [email protected] 1
Service de Chirurgie he´patobiliaire Et Digestive, CHU Rennes, 2 Rue Henri le Guilloux, 35000 Rennes, France
2
Universite´ de Rennes, 35000 Rennes, France
3
UMR Inserm 1241, NuMeCan, Nutrition Metabolisme Et Cancer, 35000 Rennes, France
Introduction Leiomyosarcoma (LMS) is a rare tumor arising from mesenchymal smooth cells. It accounts for 5–7% of all soft-tissue sarcomas (STSs) [1]. In 2% of cases, LMS develops in large vessels, with 60% in the IVC [2]. Some rare cases have been reported in the literature, including portal [3, 4], renal [5], splenic [6] or mesenteric [7] vein LMS. To date, no vascular LMS risk factors have been identified. Usually, IVCL has no specific symptoms that could explain the delayed diagnosis, sometimes occurring even at an advanced stage. Surgical resection with clear margins remains the only curative treatment and should be performed in a sarcoma referral center [8]. The management of STS, including LMS of the inferior vena cava, is currently being outlined by sarcoma working groups, especially the European Society of Medical Oncology (ESMO) [8]. Following appropriate imagery assessments, such as magnetic resonance imaging (MRI) or computed
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World J Surg
tomography scan (CT scan), the ESMO recommends a histopathological diagnosis confirmed by a sarcoma pathologist for all suspected sarcoma diagnoses. Most often, multiple percutaneous biopsies are
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