Journal of Surgical Oncology 2015;111:487
LETTER TO THE EDITOR Leiomyosarcoma of the Inferior Vena Cava LEVI SANDRI GIOVANNI BATTISTA, MD,1,2* SULPICE LAURENT, MD, PhD,1 RAYAR MICHEL, MD,1 FRANCESCO GUERRA, MD,2 BOUDJEMA KARIM, MD,1 AND MEUNIER BERNARD, MD, PhD1 2
1 Service de Chirurgie He´pato-Biliaire et Digestive, CHU Rennes, Universite´ Rennes 1, France Department of General Surgery, Umberto I Policlinic of Rome, Sapienza University of Rome, Rome, Italy
Dear Editor, We read with interest the recent manuscript published by Wachtel et al. [1] entitled “Resection of Primary Leiomyosarcoma of the Inferior Vena Cava (IVC) with Reconstruction: A Case Series and Review of the Literature.” The authors described the experience at the University of Pennsylvania with surgical management of primary leiomyosarcoma of the inferior vena casa (IVC).Threeof six patients underwent a venovenous bypass and one patient had cardiopulmonary bypass. We agree with the authors that because of a low prevalence of IVC leiomyosarcoma and due to the lack of analytical evidence from large series, no real consensus has been reached on the appropriate surgical management. The prognosis is poor and directly depends on the extent of the surgical resection. In our center, we have experience with eight cases of IVC leiomyosarcoma. There were six women and two men, median age 65.5 years (range 30–77 years). Median tumor size was 4 cm (range 3–24 cm). In seven cases (87.5%), the presenting symptom was abdominal pain, in one case (12.5%) intestinal obstruction. Similarly to the series of Watchel et al., none of our patients developed lower limb edema. None of the patients had history of radiation to the abdomen. According to the Fédération Nationale des Centres de Lutte Contre le Cancer classification, there were two grade 1 tumors (25%), four grade 2 (50%) and two grade 3 (25%). The tumor involved level II in four patients (50%), levels II and III in two patients (25%) and levels I and II in two patients (25%). IVC resection was performed in seven patients (87.5%) followed by reconstruction with a PTFE prosthesis measuring 16–20 mm (16 mm, n ¼ 1; 18 mm, n ¼ 3; 20 mm, n ¼ 3). In one patient, local resection was sufficient. Due to local recurrence, one patient had vena cava replacement under veno-venous bypass and liver hypothermic perfusion associated with a left
hepatectomy, due to the involvement of the left and middle hepatic veins was performed [2]. We agree with the authors regarding the necessity for multidisciplinary treatment planning involving pathologists, radiologists, surgeons and oncologists. Our large experience with orthotopic liver transplantation was very helpful in those eight cases. We emphasize that the role of adjuvant treatments with radiation or chemotherapy remains a subject of debate. Doxarubicin plus ifosfamide has been proposed for patients with an acceptable general status and a marginally resectable or high-grade tumor. However, for inoperable tumors, palliative chemotherapy has not provided any improvement in survival [3]. Long-term survival has only been observed after curative resection [4]. In cases of disease recurrence, when possible, a surgical procedure should be performed to increase overall survival.
References 1. Wachtel H, Jackson BM, Bartlett EK, et al.: Resection of primary leiomyosarcoma of the inferior vena cava (IVC) with reconstruction: A case series and review of the literature. J Surg Oncol 2014; DOI: 10.1002/jso.23798. 2. Levi Sandri GB, Sulpice L, Boudjema K, et al.: Hepatobiliary and pancreatic: Leiomyosarcoma of the inferior vena cava. J Gastroenterol Hepatol 2014;29:896.DOI:10.1111/jgh.12591. 3. Ganeshalingam S, Rajeswaran G, Jones RL, et al.: Leiomyosarcomas of the inferior vena cava: Diagnostic features on cross-sectional imaging. Clin Radiol 2011;66:50–56. 4. Ito H, Hornick JL, Bertagnolli MM, et al.: Leiomyosarcoma of the inferior vena cava: Survival after aggressive management. Ann Surg Oncol 2007;14:3534–3541.
*Correspondence to: Giovanni Battista Levi Sandri, MD, Service de Chirurgie Hépatobiliaire et Digestive. Centre Hospitalier Universitaire de Rennes, Université de Rennes 1, France. Fax: þ33-299-28-41-29. E-mail: [email protected] Received 23 October 2014; Accepted 30 October 2014 DOI 10.1002/jso.23850 Published online 5 December 2014 in Wiley Online Library (wileyonlinelibrary.com).
ß 2014 Wiley Periodicals, Inc.
LETTER TO THE EDITOR Leiomyosarcoma of the Inferior Vena Cava LEVI SANDRI GIOVANNI BATTISTA, MD,1,2* SULPICE LAURENT, MD, PhD,1 RAYAR MICHEL, MD,1 FRANCESCO GUERRA, MD,2 BOUDJEMA KARIM, MD,1 AND MEUNIER BERNARD, MD, PhD1 2
1 Service de Chirurgie He´pato-Biliaire et Digestive, CHU Rennes, Universite´ Rennes 1, France Department of General Surgery, Umberto I Policlinic of Rome, Sapienza University of Rome, Rome, Italy
Dear Editor, We read with interest the recent manuscript published by Wachtel et al. [1] entitled “Resection of Primary Leiomyosarcoma of the Inferior Vena Cava (IVC) with Reconstruction: A Case Series and Review of the Literature.” The authors described the experience at the University of Pennsylvania with surgical management of primary leiomyosarcoma of the inferior vena casa (IVC).Threeof six patients underwent a venovenous bypass and one patient had cardiopulmonary bypass. We agree with the authors that because of a low prevalence of IVC leiomyosarcoma and due to the lack of analytical evidence from large series, no real consensus has been reached on the appropriate surgical management. The prognosis is poor and directly depends on the extent of the surgical resection. In our center, we have experience with eight cases of IVC leiomyosarcoma. There were six women and two men, median age 65.5 years (range 30–77 years). Median tumor size was 4 cm (range 3–24 cm). In seven cases (87.5%), the presenting symptom was abdominal pain, in one case (12.5%) intestinal obstruction. Similarly to the series of Watchel et al., none of our patients developed lower limb edema. None of the patients had history of radiation to the abdomen. According to the Fédération Nationale des Centres de Lutte Contre le Cancer classification, there were two grade 1 tumors (25%), four grade 2 (50%) and two grade 3 (25%). The tumor involved level II in four patients (50%), levels II and III in two patients (25%) and levels I and II in two patients (25%). IVC resection was performed in seven patients (87.5%) followed by reconstruction with a PTFE prosthesis measuring 16–20 mm (16 mm, n ¼ 1; 18 mm, n ¼ 3; 20 mm, n ¼ 3). In one patient, local resection was sufficient. Due to local recurrence, one patient had vena cava replacement under veno-venous bypass and liver hypothermic perfusion associated with a left
hepatectomy, due to the involvement of the left and middle hepatic veins was performed [2]. We agree with the authors regarding the necessity for multidisciplinary treatment planning involving pathologists, radiologists, surgeons and oncologists. Our large experience with orthotopic liver transplantation was very helpful in those eight cases. We emphasize that the role of adjuvant treatments with radiation or chemotherapy remains a subject of debate. Doxarubicin plus ifosfamide has been proposed for patients with an acceptable general status and a marginally resectable or high-grade tumor. However, for inoperable tumors, palliative chemotherapy has not provided any improvement in survival [3]. Long-term survival has only been observed after curative resection [4]. In cases of disease recurrence, when possible, a surgical procedure should be performed to increase overall survival.
References 1. Wachtel H, Jackson BM, Bartlett EK, et al.: Resection of primary leiomyosarcoma of the inferior vena cava (IVC) with reconstruction: A case series and review of the literature. J Surg Oncol 2014; DOI: 10.1002/jso.23798. 2. Levi Sandri GB, Sulpice L, Boudjema K, et al.: Hepatobiliary and pancreatic: Leiomyosarcoma of the inferior vena cava. J Gastroenterol Hepatol 2014;29:896.DOI:10.1111/jgh.12591. 3. Ganeshalingam S, Rajeswaran G, Jones RL, et al.: Leiomyosarcomas of the inferior vena cava: Diagnostic features on cross-sectional imaging. Clin Radiol 2011;66:50–56. 4. Ito H, Hornick JL, Bertagnolli MM, et al.: Leiomyosarcoma of the inferior vena cava: Survival after aggressive management. Ann Surg Oncol 2007;14:3534–3541.
*Correspondence to: Giovanni Battista Levi Sandri, MD, Service de Chirurgie Hépatobiliaire et Digestive. Centre Hospitalier Universitaire de Rennes, Université de Rennes 1, France. Fax: þ33-299-28-41-29. E-mail: [email protected] Received 23 October 2014; Accepted 30 October 2014 DOI 10.1002/jso.23850 Published online 5 December 2014 in Wiley Online Library (wileyonlinelibrary.com).
ß 2014 Wiley Periodicals, Inc.
