ASO Author Reflections: Portal Vein Leiomyosarcoma: How to Perform a Major Hepatectomy with Biliary and Portal Vein Reco
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ASO AUTHOR REFLECTIONS
ASO Author Reflections: Portal Vein Leiomyosarcoma: How to Perform a Major Hepatectomy with Biliary and Portal Vein Reconstruction Using an Autogenous External Iliac Vein Interposition Graft Stylianos Tzedakis, MD, and Karim Boudjema, MD, PhD Department of Hepatobiliary and Digestive Surgery, Pontchaillou University Hospital, Rennes, France
PAST Vascular leiomyosarcomas (LMSs) represent only 2% of soft tissue sarcomas and most commonly (50%) originate from the inferior vena cava, renal vein, and great saphenous vein.1–3 Portal vein LMSs are very rare, and the 4-year survival rate is estimated to be 32%. Surgical resection currently is the only realistic chance of long-term survival but demands complex liver surgery procedures with vascular reconstructions. Currently, advances in liver and vascular surgery as well as perioperative patient management may offer a greater chance for surgical resection. PRESENT Regarding treatment, surgeons manage most soft tissue sarcomas with surgical resection for localized primary tumors. These resections combine en bloc negative margin sarcoma surgery principles and complex liver surgery procedures with vascular reconstructions.3–5 From the technical point of view, the authors’ video shows how to approach tumor resection without compromising R0 resection due to its difficult central location in the hepatic pedicle confluence. Furthermore, it shows how to perform complex vascular reconstruction using an autologous vascular graft to avoid prosthetic vascular complications such as infection and thrombosis. These resections generally borrow surgical techniques from hilar
Ó Society of Surgical Oncology 2020 First Received: 9 August 2020 Accepted: 15 August 2020 S. Tzedakis, MD e-mail: [email protected]
cholangiocarcinoma surgery (biliary confluence resection) and liver transplantation (autogenous iliac vein graft portal vein reconstructions). Although feasible and safe, these resections should be well codified and restricted to highvolume hepatobiliary centers. FUTURE Portal vein leiomyosarcomas are extremely rare. Liver surgery with complex vascular resections for en bloc extensive surgical resection is feasible and safe. The surgical strategy should be well planned and codified to minimize surgical morbidity and to achieve R0 resections and prolonged survival. DISCLOSURE interest.
The authors declare that they have no conflict of
REFERENCES 1. Dzsinich C, Gloviczki P, van Heerden JA, Nagorney DM, Pairolero PC, Johnson CM, et al. Primary venous leiomyosarcoma: a rare but lethal disease. J Vasc Surg. 1992;15:595–603. 2. Gage MJ, Patel AV, Koenig KL, Newman E. Non-vena cava venous leiomyosarcomas: a review of the literature. Ann Surg Oncol. 2012;19:3368–74. 3. Chiu WHK, Lo AWI, Lee JKT. Leiomyosarcoma of the portal vein: a case report and review of the literature. BJR Case Rep. 2017;2:20160125. 4. Boudjema K, Sulpice L, Levi Sandri GB, Meunier B. Portal vein leiomyosarcoma, an unusual cause of jaundice. Dig Liver Dis. 2014;46:1053–4. 5. Tzedakis S, Jeddou H,
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