Surgical resection and graft replacement for primary inferior vena cava leiomyosarcoma: A multicenter experience

Abstract Objective

Primary leiomyosarcomas of the inferior vena cava (IVC) are best managed with surgical resection when technically feasible, however there is a lack of consensus regarding the best choice of conduit and reconstruction technique. The aim of this multicenter study was to perform a comprehensive assessment through the Vascular Low Frequency Disease Consortium (VLFDC) to determine the most effective method for caval reconstruction after resection of primary leiomyosarcoma of the IVC.

Methods

A multicenter, standardized database review of patients undergoing surgical resection and reconstruction of the IVC for primary leiomyosarcomas from 2007-2017 was performed. Demographics, periprocedural details, and post-operative outcomes were analyzed.

Results

A total of 92 patients (60 women and 32 men) were treated with a mean age of 60.1 years (range 30-88). Metastatic disease was present in 22%. Tumor location was distributed as: 53% (n=49) below the renal veins; 57% (n=52) between renal and hepatic veins; and 14% (n=13) above the hepatic veins. Conduits for reconstruction included: ringed polytetrafluoroethylene (PTFE) (n=80), non-ringed PTFE (n=1), Dacron (n=1), autogenous vein (n=1), bovine pericardium (n=4), cryopreserved tissue (n=5). Complete R0 resection was accomplished in 79% (n=73). In-hospital mortality was 2% with a median length of stay of 8 days. When comparing PTFE to non-PTFE reconstructions, primary patency of PTFE reconstructed IVCs was 97% and 92% at 1 year and 5 years respectively compared with 73% at 1 and 5 years amongst the non-PTFE reconstructed IVCs. Overall one, three, and five-year survival for the entire cohort were 94%, 86%, and 65%, respectively

Conclusions

This multi-institutional study demonstrates that complete en bloc resection of IVC leiomyosarcomas with vascular surgical reconstruction in selected patients results in low perioperative mortality and is associated with excellent long-term patency. Ringed PTFE graft is the most commonly utilized conduit for caval reconstruction and yields excellent long-term primary patency.

Article InfoPublication History

Accepted: June 30, 2021

Received: January 26, 2021

Publication stageIn Press Journal Pre-ProofFootnotes

Presented at the Vascular Annual Meeting

Von Liebig plenary session - June 20, 2020

Declaration of Conflicting interests

Dr. Eskandari has received honoraria from Silk Road Medical, Inc. for service on the Roadster Clinical Events Committee; and from W. L. Gore & Associates as a TEVAR course director.

ARTICLE HIGHLIGHTS

Type of Research: Multicenter, retrospective analysis of a Vascular Low Frequency Disease Consortium (VLFDC) collected registry.

Key Findings: The long-term patency of inferior vena cava (IVC) reconstruction after leiomyosarcoma resection using PTFE was significantly greater than those with a non-PTFE reconstruction (p=.02). The one, three, and five-year patency rates in the PTFE reconstruction group were 97%, 92%, and 92%, compared to 73% in the non-PTFE reconstruction group. Overall one, three, and five-year survival for the entire cohort were 94%, 86%, and 65%, respectively.

Take home Message: This multi-institutional study demonstrates that complete en bloc resection of IVC leiomyosarcomas with vascular surgical reconstruction in selected patients results in low perioperative mortality and is associated with excellent long-term patency. Ringed PTFE graft is the most commonly utilized conduit for IVC reconstruction and yields excellent long-term primary patency.

Table of Contents Summary

This retrospective multicenter study analyzed the results after resection and reconstruction of primary Inferior Vena Cava (IVC) leiomyosarcoma in 92 patients and found that repair with PTFE had greater long-term patency than non-PTFE conduits for IVC reconstructions. The study suggests that PTFE is an acceptable conduit for IVC reconstruction after resection in patients with leiomyosarcomas.

Identification

DOI: https://doi.org/10.1016/j.jvsv.2021.06.021

Copyright

© 2021 Published by Elsevier Inc. on behalf of the Society for Vascular Surgery.

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