Wachtel Heather, Jackson Benjamin M, Bartlett Edmund K, Karakousis Giorgos C, Roses Robert E, Bavaria Joseph E, Fraker Douglas L
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
J Surg Oncol. 2015 Mar;111(3):328-33. doi: 10.1002/jso.23798. Epub 2014 Oct 8.
Leiomyosarcoma of the inferior vena cava (IVC) is a rare tumor which presents a unique surgical challenge. We present a series of six cases of leiomyosarcoma resection performed with IVC reconstruction.
Retrospective chart review was performed for patients undergoing initial operative resection of primary leiomyosarcoma with IVC reconstruction, at a tertiary care center.
Between 2005-2013, six patients underwent resection with reconstruction. Half were female, and the mean age at presentation was 57 ± 15.4 years. Three patients required en bloc resection with adjacent organs. Three patients were resected on venovenous bypass, and one on cardiopulmonary bypass. Three underwent IVC patch repair (bovine pericardium, n = 2; saphenous vein, n = 1), and three had IVC reconstruction with graft (Dacron, n = 1; PTFE, n = 1; aortic homograft, n = 1). All achieved grossly negative margins. Median disease-free survival was 34 months (IQR 7-52 months), and median disease-specific survival was 51 months (IQR 20-108). Five year disease-free and disease-specific survival rates were 30% and 66.7%, respectively.
Leiomyosarcomas of the IVC present a technical challenge to the surgeon. Careful preoperative workup and a collaborative team consisting of experienced cardiac and vascular surgeons and surgical oncologists can allow for a safe and successful operation despite extensive tumor involvement.
下腔静脉平滑肌肉瘤是一种罕见肿瘤，对手术提出了独特挑战。我们报告了一系列6例进行下腔静脉重建的平滑肌肉瘤切除术病例。
对在一家三级医疗中心接受原发性平滑肌肉瘤初次手术切除并进行下腔静脉重建的患者进行回顾性病历审查。
2005年至2013年期间，6例患者接受了重建性切除术。一半为女性，就诊时的平均年龄为57±15.4岁。3例患者需要与相邻器官进行整块切除。3例患者在静脉-静脉转流下进行切除，1例在体外循环下进行切除。3例患者接受了下腔静脉补片修复（牛心包，n = 2；大隐静脉，n = 1），3例患者用移植物进行了下腔静脉重建（涤纶，n = 1；聚四氟乙烯，n = 1；主动脉同种异体移植物，n = 1）。所有患者均实现了切缘大体阴性。无病生存期的中位数为34个月（四分位间距7 - 52个月），疾病特异性生存期的中位数为51个月（四分位间距20 - 108个月）。5年无病生存率和疾病特异性生存率分别为30%和66.7%。
下腔静脉平滑肌肉瘤对外科医生来说是一项技术挑战。尽管肿瘤广泛累及，但仔细的术前检查以及由经验丰富的心脏和血管外科医生及外科肿瘤学家组成的协作团队可实现安全且成功的手术。
