Clinical Outcomes of Surgical Resection for Leiomyosarcoma of the Inferior Vena Cava

Ann Vasc Surg. 2019 Nov;61:377-383. doi: 10.1016/j.avsg.2019.05.053. Epub 2019 Aug 5.

Abstract

Background: Leiomyosarcoma of the inferior vena cava (IVC) is a rare mesenchymal tumor with poor prognosis. Surgical resection is currently the only potential curative treatment. This study analyzed long-term outcomes of patients who underwent surgical resection of leiomyosarcoma of the IVC.

Methods: The charts of 12 patients who underwent surgical resection of leiomyosarcoma of the IVC from January 1999 to December 2017 at a single center were retrospectively reviewed.

Results: Of the 12 patients, 10 (83.3%) were women. Median age at diagnosis was 63 years (range 42-67). Leiomyosarcoma involved the middle segment of the IVC in 9 patients (75.5%) and the lower segment in 3 (25.0%). Ten patients underwent IVC resection, followed by reconstruction with polytetrafluoroethylene in 9 patients and a bovine patch in 1. Two patients underwent IVC resection followed by ligation of the IVC. Eleven patients (91.7%) underwent grossly radical resection, with 1 (8.3%) having peritoneal seeding at the first operation. After resection, 8 patients received adjuvant chemotherapy and 7 received adjuvant radiotherapy. No patient experienced regional recurrence at the resection margins of the IVC, but 9 patients (75.5%) experienced distant metastases to sites such as the lungs, liver, bones, pelvis, peritoneum, and scalp. Median follow-up was 41 months (range 6-149). Median disease-free survival (DFS) was 49 months (range 8-88), and median overall survival (OS) was 127 months (range 25-149). The 3- and 5-year DFS rates were 77.9% and 39.0%, respectively, and the 3-, 5-, and 10-year OS rates were 87.5%, 75.0%, and 56.3%, respectively.

Conclusions: Although there is no established treatment for leiomyosarcoma of the IVC and metastasis after surgery is frequent, surgical resection followed by chemotherapy and/or radiotherapy can enhance long-term survival.

MeSH terms

  • Adult
  • Aged
  • Chemotherapy, Adjuvant
  • Disease Progression
  • Disease-Free Survival
  • Female
  • Humans
  • Leiomyosarcoma / diagnostic imaging
  • Leiomyosarcoma / mortality
  • Leiomyosarcoma / secondary
  • Leiomyosarcoma / surgery*
  • Male
  • Margins of Excision
  • Middle Aged
  • Radiotherapy, Adjuvant
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Vascular Neoplasms / diagnostic imaging
  • Vascular Neoplasms / mortality
  • Vascular Neoplasms / pathology
  • Vascular Neoplasms / surgery*
  • Vascular Surgical Procedures* / adverse effects
  • Vascular Surgical Procedures* / mortality
  • Vena Cava, Inferior / diagnostic imaging
  • Vena Cava, Inferior / pathology
  • Vena Cava, Inferior / surgery*