THE EFFECT OF EXTENT OF CAVAL RESECTION IN THE TREATMENT OF INFERIOR VENA-CAVA LEIOMYOSARCOMA

Background. A wide and complete surgical resection is the principle mo dality of therapy in the management of retroperitoneal sarcomas. It is current opinion that, also for inferior vena cava (IVC) leiomyosarcom as, an extended resection of either retroperitoneal tissue and vena ca va should be performed. The aim of the study was to investigate the in fluence of the venous extent of resection on local recurrence and long -term outcome. Methods. Up to August 1994, 218 patients were enrolled into The International Registry of Inferior Vena Cava (IVC) Leiomyosar comas. For the purpose of this study we considered 120 patients who un derwent a radical resection of the IVC tumor (i.e. removal of all gros s disease with microscopic tumor-free margins and no evidence of dista nt metastases). Resection included an IVC rim in 53 patients and an IV C a segment in 67. Results. There were 3 (2.5%) early postoperative de aths and 7 (5.8%) major complications. Postoperative deep venous throm bosis of the lower limbs was diagnosed in 21 (17.5%) patients and was treated by anticoagulant therapy and/or elastic stocking without long- term sequelae. Overall, tumor recurrence was observed in 67 (57.3%) pa tients at a mean follow-up of 32 +/- 4 months. Seven, 13 and 4 patient s who underwent caval wall resection and 9, 29 and 5 patients submitte d to a caval segmental resection had either local recurrences, distant metastases or local and distant metastases (p = NS). Survival rates o f the two groups were 55% and 37% at 5- year and 42% and 23% at 10-yea r, respectively (p = NS). Conclusion. An extended venous resection in IVC leiomyosarcoma does not influence local recurrence rate nor long-t erm outcome.