Simultaneous surgery for infrahepatic inferior vena cava leiomyosarcoma with multiple liver metastasis

Abstract

Introduction: Leiomyosarcoma of the inferior vena cava (IVC) is a rarely encountered malignancy originating from the smooth muscle cells of media of IVC, and only a few cases of the resection of IVC leiomyosarcomas with synchronous liver metastases have been reported. We report a simultaneous resection of infrahepatic IVC leiomyosarcoma replaced with polytetrafluoroethylene (PTFE) graft and liver metastasis as volume reduction followed by chemotherapy. Method: A 42-year-old male presented elastic hard abdominal mass in the right upper quadrant. He was diagnosed as leiomyosarcoma 9cm in diameter of infrahepatic IVC with multiple liver metastasis and was referred to our hospital. Via cancer board, resection of the primary lesion and volume reduction hepatectomy for multiple liver metastasis followed by chemotherapy was approved. He underwent tumor involving infrahepatic IVC resection, reconstruction with PTFE graft, and partial hepatectomy of segment 5,7, and 8. Result: The postoperative course of the patient was uneventful and the graft patency was retained by auxiliary with aspirin from postoperative day (POD) 4th. Histopathological examination revealed leiomyosarcoma arising from IVC with high level of Ki-67 index. He discharged on POD 28th and was continuously treated by chemotherapy with adriamycin and ifosfamide followed by eribulin. He was alive with multiple liver metastasis at 9 months after surgery. Conclusion: Although the ideal treatment of choice of IVC leiomyosarcoma with liver metastasis is radical en-bloc excision aimed to obtain a negative resection margin, resection of the primary lesion replaced by PTFE graft and volume reduction hepatectomy followed by chemotherapy may be one alternative option of therapeutic strategies.