Surgical Approach to Retroperitoneal Sarcomas with Involvement of the Permeable Inferior Vena Cava: Use of the Femorojugular Bypass

Abstract

Introduction: Retroperitoneal sarcomas with Inferior Vena Cava (IVC) involvement are rare cases and complex to manage. Radical surgical resection is the only potentially curative treatment and sometimes clamping of the IVC is necessary, which can cause hemodynamic alterations. In this study, we describe the use of femorojugular bypass with perfusion pump as a technique to optimize the hemodynamic situation during the resection of retroperitoneal sarcomas with IVC involvement. Methods: We collected data from patients presenting with retroperitoneal sarcomas with IVC involvement operated at the Hospital de la Santa Creu i Sant Pau (Barcelona), a sarcoma referral center, between March 2021 and May 2023. The technical details of the surgical procedures were analyzed, including the IVC involvement, surgical approach to treatment, and the use of femorojugular bypass. Postoperative complications and oncologic outcomes were also recorded. Results: A total of seven patients diagnosed with retroperitoneal sarcoma with IVC involvement were operated on. In two of the cases, a femorojugular bypass was performed prior to clamping the IVC. In five of the cases, radical resection of the tumor was achieved without leaving macroscopic disease. The mean estimated blood loss was 2.21 L and there was no postoperative mortality. Overall survival was 75% at 12 months with a mean follow-up of 11.86 months. Conclusion: The use of femorojugular bypass during the resection of retroperitoneal sarcomas with IVC involvement may improve the hemodynamic situation of the patient and allow for complete tumor resection. This multidisciplinary surgical approach in referral centers may be effective in the treatment of this rare disease. However, further studies are needed to confirm these results and to establish standardized management guidelines.