Prosthetic replacement of the infrahepatic inferior vena cava for leiomyosarcoma.

HYPOTHESIS

Resection of the infrahepatic inferior vena cava associated with prosthetic graft replacement for caval leiomyosarcoma is an acceptable procedure to obtain prolonged and good-quality survival.

DESIGN

A consecutive sample clinical study with a mean follow-up of 40 months.

SETTING

The surgical department of an academic tertiary center and an affiliated secondary care center.

PATIENTS

Eleven patients, with a mean age of 51 years, who have primary leiomyosarcoma of the infrahepatic inferior vena cava.

INTERVENTIONS

All of the patients underwent radical resection of the tumor en bloc with the affected segment of the vena cava. Reconstruction consisted of 10 cavocaval polytetrafluoroethylene grafts and 1 cavobiliac graft. An associated right nephrectomy was performed in 2 cases. The left renal vein was reimplanted in the graft in 3 cases.

MAIN OUTCOME MEASURES

Cumulative disease-specific survival, disease-free survival, and graft patency rates expressed by standard life-table analysis.

RESULTS

No patients died in the postoperative period. The cumulative (SE) disease-specific survival rate was 53% (21%) at 5 years. The cumulative (SE) disease-free survival rate was 44% (19%) at 5 years. The cumulative (SE) graft patency rate was 67% (22%) at 5 years.

CONCLUSION

Radical resection followed by prosthetic graft reconstruction is a valuable method for treating primary leiomyosarcoma of the infrahepatic inferior vena cava.