Leiomyosarcoma of the Vena Cava. A Case Report of Resection of the Infrarenal Cava with Auto-transplantation of Both Kidneys

Abstract

Introduction: Leiomyosarcoma of the IVC is a rare but potentially fatal condition where a complete R0 resection is the only potential cure. Since the first case of a leiomyosarcoma described back in 1871 there have been approximately 470 cases reported in the literature with varying techniques used to manage the cava and so a consensus on best surgical management has never been reached[1].We present a rare case of a Leiomyosarcoma of section II of the inferior vena cava with auto transplantation of both kidneys. Methods: Intra-operatively there was a very large bilobed leiomyosarcoma originating from the IVC at the level of the renal veins and growing around the porta hepatitis and below the liver. the liver was fully mobilised to allow exposure of the cava and facilitate tumour resection. In order to preserve both kidneys they were resected and auto transplanted into the pelvis at the end of the procedure. The tumour was resected with approximately 10cm of IVC and replaced with a PTFE tube graft. Results: Postoperative course was stormy complicated by perinephric haematomas, chest sepsis and delayed graft function. She spent 11 days in ICU (9 on CRRT) and was discharged home on day 27 with a creatinine of 61 Pathology was confirmed as a grade 3 leiomyosarcoma arising from the wall of the inferior vena cava. It wasn't possible to assess excision margins due to the fragmented specimen however sampled blood vessels and small amount of adherent liver parenchyma were clear of infiltration. Conclusion: Tumours involving the inferior vena cava remain a rare pathology with radical resection as the only option for improving long term survival. Resection of the cava can be achieved with or without replacement depending on collateral venous drainage and the location of the renal veins in relation to the resected segment. This case demonstrates a new surgical option for achieving R0 resection margins and avoiding renal dysfunction with autologous bilateral renal transplants. Disclosure: Nothing to disclose