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Original Article
September 1, 2006

Prosthetic Replacement of the Infrahepatic Inferior Vena Cava for Leiomyosarcoma

Author Affiliations

Author Affiliations: The [[ldquo]]Francesco Durante[[rdquo]] Department of Surgery, University of Rome [[ldquo]]La Sapienza,[[rdquo]] Rome (Drs Illuminati, D[[rsquo]]Urso, Giacobbi, Papaspyropoulos, and Ceccanei), and the Unit of Vascular Surgery, Sant[[rsquo]]Anna Hospital, Catanzaro (Dr Calio[[rsquo]]), Italy.

Arch Surg. 2006;141(9):919-924. doi:10.1001/archsurg.141.9.919

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.