Surgical Management of Inferior Vena Cava Leiomyosarcoma

Inferior vena cava leiomyosarcoma is a rare but aggressive malignant tumour arising from the smooth muscle layer of the IVC, typically presenting insidiously with non-specific symptoms such as abdominal discomfort, lower limb oedema and venous thrombosis. Surgical resection remains the cornerstone of curative treatment, aiming for negative margins through en bloc removal of the tumour and involved cava segment. Technical challenges depend on the tumour level, with infrarenal, pararenal and suprahepatic involvement necessitating different reconstruction strategies. Prosthetic graft replacement, cavoplasty with renal vein reinsertion and autologous vein patching have all been employed to maintain venous return and prevent postoperative congestion. In specialised centres, extended resections involving adjacent organs—including the liver, pancreas and kidney—and vascular reconstruction under vascular exclusion or cardiopulmonary bypass are increasingly feasible. While perioperative morbidity remains significant, advances in imaging, multidisciplinary planning and tailored reconstruction have improved long-term survival, underscoring the global importance of centre-based collaborative care in managing this challenging disease.

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Surgical Management of Inferior Vena Cava Leiomyosarcoma publication trend

The graph below shows the total number of articles in surgical management of inferior vena cava leiomyosarcoma across all publications each year (not limited to Nature Index journals).

Technical terms

Leiomyosarcoma: Malignant tumour arising from smooth muscle cells within blood vessel walls.

Inferior vena cava (IVC): The major abdominal vein returning deoxygenated blood from the lower body to the heart.

En bloc resection: Surgical removal of a tumour and adjacent tissues in one single piece to ensure clear margins.

Ex vivo liver resection and autotransplantation (ELRA): Procedure in which the liver is removed to excise tumour tissue outside the body and then reimplanted.

Cavoplasty: Surgical repair or reshaping of the vena cava wall, often including patching to restore vessel patency.

References

1. Leiomyosarcoma of the inferior vena cava: Clinical experience with four cases. World Journal of Surgical Oncology (2006).
2. Pancreatic and multiorgan resection with inferior vena cava reconstruction for retroperitoneal leiomyosarcoma. World Journal of Surgical Oncology (2009).
3. Leiomyosarcoma of the inferior vena cava: Radical surgery and vascular reconstruction. World Journal of Surgical Oncology (2009).
4. Ex Vivo Liver Resection and Autotransplantation as Surgical Option for Zone II–III Leiomyosarcoma of IVC: A Case Report and Literature Review. Frontiers in Oncology (2021).