Leiomyosarcoma Of The Inferior Vena Cava: Feasibility Of Surgical Resection. A Report Of Two Cases

Leiomyosarcoma of the inferior vena cava (IVC) is an extremely rare malignant tumor of the venous system and retroperitoneum (1). Retroperitoneal sarcomas may arise primarily from IVC or involve it secondarily (2). Due to its location, there is a lack of accurate and early symptoms, and these kinds of tumors are not diagnosed until the disease is at an advanced stage, with large tumor growth and involvement of surrounding structures. Clinical symptoms are unspecific, and for diagnosis, imaging tests such as color Doppler ultrasonography, contrast-enhanced computed tomography or magnetic resonance are required. Currently, to improve prognosis and provide long-term survival, radical en bloc/complete resection of the affected venous segment is the best treatment option (1,3,4). The goals of surgical procedure must include: Local tumor control, maintenance of cava flow, and the prevention of recurrence (4). The main classification used in the planning of a surgical approach divides the IVC into: An upper segment (above the hepatic veins), a middle segment (between hepatic and renal veins), and lower segment (below the renal veins). Furthermore, handling of the IVC after tumor resection is controversial, i.e. primary repair, ligation or reconstruction of the IVC have all been utilized with varying degrees of success (1). In this context, three important factors affect the need and the type of vascular replacement: a) The site of the lesion, and especially the involvement of renal veins; b) the extent of IVC resection (partial or circumferential); and finally c) the presence of a well-established collateral venous system (2). We present two cases of leiomyosarcoma of the IVC, focusing on the type of surgical procedure and oncological outcome.