Clinical Outcomes of Surgical Resection for Leiomyosarcoma of the Inferior Vena Cava

Leiomyosarcoma of the inferior vena cava (IVC) is a rare mesenchymal tumor with poor prognosis. Surgical resection is currently the only potential curative treatment. This study analyzed long-term outcomes of patients who underwent surgical resection of leiomyosarcoma of the IVC. The charts of 12 patients who underwent surgical resection of leiomyosarcoma of the IVC from January 1999 to December 2017 at a single center were retrospectively reviewed. Of the 12 patients, 10 (83.3%) were women. Median age at diagnosis was 63 years (range 42–67). Leiomyosarcoma involved the middle segment of the IVC in 9 patients (75.5%) and the lower segment in 3 (25.0%). Ten patients underwent IVC resection, followed by reconstruction with polytetrafluoroethylene in 9 patients and a bovine patch in 1. Two patients underwent IVC resection followed by ligation of the IVC. Eleven patients (91.7%) underwent grossly radical resection, with 1 (8.3%) having peritoneal seeding at the first operation. After resection, 8 patients received adjuvant chemotherapy and 7 received adjuvant radiotherapy. No patient experienced regional recurrence at the resection margins of the IVC, but 9 patients (75.5%) experienced distant metastases to sites such as the lungs, liver, bones, pelvis, peritoneum, and scalp. Median follow-up was 41 months (range 6–149). Median disease-free survival (DFS) was 49 months (range 8–88), and median overall survival (OS) was 127 months (range 25–149). The 3- and 5-year DFS rates were 77.9% and 39.0%, respectively, and the 3-, 5-, and 10-year OS rates were 87.5%, 75.0%, and 56.3%, respectively. Although there is no established treatment for leiomyosarcoma of the IVC and metastasis after surgery is frequent, surgical resection followed by chemotherapy and/or radiotherapy can enhance long-term survival.