Short- and Long-term Results of Complete Resection and Vascular Reconstruction for Infrahepatic Inferior Vena Cava Leiomyosarcomas: A Retrospective Case Series of 33 Patients

Background/Aim: Inferior vena cava (IVC) leiomyosarcoma is a rare malignant tumor, with fewer than 500 cases described in literature. Prognosis is poor, and radical surgical resection remains the gold standard of treatment. However, the optimal surgical technique is a subject of ongoing debate. Patients and Methods: From October 1993 to December 2024, 33 patients (23 females, 10 males; median age 52.2 years) underwent surgical resection of IVC leiomyosarcoma with vascular reconstruction using a polytetrafluoroethylene (PTFE) graft. A multidisciplinary team evaluated all patients. The surgical procedure involved en bloc resection of the tumor with a minimum 1 cm healthy margin. The reconstruction was cavo-caval, cavo-bi-iliac, cavo-caval with right renal vein resection and right nephrectomy and cavo-caval with left renal vein resection and reimplantation. Study's primary endpoints were overall survival, disease-free survival and graft patency. Secondary endpoints were intraoperative and postoperative complications. Results: No 30-day postoperative mortality was observed. Five- and 10-year survival rates were 57.7% and 15.2%, respectively. Five- and 10-year disease-free survival rates were 36.4% and 18.2%, respectively. Graft thrombosis was observed in 13 patients (39.4%). Median follow-up was 48 months (range=12-120 months; IQR=24.0-68.5). No cases of prosthetic infection or acute graft thrombosis were observed in this series. Postoperative complications included acute kidney injury (AKI) in four patients (12.1%), respiratory distress in two patients (6.1%) distress and postoperative bleeding in three patients (9.1%). Conclusion: Type I and II IVC leiomyosarcomas resection with subsequent PTFE vascular reconstruction is safe, with a low rate of disease-free survival and a risk of graft thrombosis at medium follow-up.