- The patient had developed leiomyosarcoma, a relatively uncommon tumour, in her inferior vena cava
- Doctors resected 15 cmsof the large blood vessel, right kidney, right ureter and ascending colon to remove the 4 kg tumour that measured 20 x 15. A long graft was used as replacement for the blood vessel
- Surgical management of such cancers requires extremely advanced facilities and a multidisciplinary team approach
Vaishali, December 15, 2020: Doctors at Max Super Speciality Hospital, Vaishali recently performed a rare surgery on a 35-year-old woman with leiomyosarcoma tumoursuccessfully resecting and accomplishing complex reconstruction after removal of tumour. A relatively uncommon tumour, it had developed in her inferior vena cava (a large vein of the body carrying blood from the legs and abdominal organs to the heart), the right kidney, right ureter and adjacent structures extending from just below her liver and occupying nearly the entire right side of the mid and lower abdomen right up to the junction of veins draining blood from right and left leg.
Leiomyosarcoma of the inferior vena cava (IVC) is an extremely rare malignant (cancerous) tumour arising from the smooth muscle lining on the walls of the IVC. Doctors resected a long length of the IVC measuring nearly 15 cm, right kidney, right ureter and ascending colon and removed the 4 kg tumour measuring 20 x 15 cm in a surgery that lasted for a little over 10 hours. Restoration of blood flow from the limbs and the left kidney was achieved by using a graft with reimplantation of the vein draining blood back from left kidney into the graft.
Operating surgeon, Dr VivekMangla, Associate Director & Head, Gastrointestinal and HPB Surgical Oncology, Max Institute of Cancer Care, Max Hospital, Vaishalisaid “The patient had been experiencing progressively increasing swelling in her right foot and leg over the last few months but got delayed in visiting the doctor due to the pandemic. Her condition worsened to the point where she could not walk at all and was brought to us on a stretcher. Upon evaluation, we found that the patient had a clot in the long segment of the deep veins of right leg (deep venous thrombosis). Further evaluation for the cause of thrombosis revealed a large, relatively uncommon tumour, leiomyosarcoma. Considering the patient’s condition and extent of tumour, we decided to start her on anticoagulation (blood thinners) to prevent extension of thrombus, as well as chemotherapy to control the growth of tumour.”
Over the next two months, her treatment continued under the careful watch of a team of doctors at Max Hospital, Vaishali during which her condition improved remarkably and there was no distant spread of the tumour. She was re-evaluated by the surgical team comprising Dr VikasGoswami, Senior Consultant, Medical Oncology &Hematology; Dr Abhishek Agarwal, Principal Consultant, Radiology; Dr Subhashish Das, Associate Director, Gastroenterologist and Hepatologist; Dr Kapil Gupta, Sr. Consultant and In-charge (Vascular and Endovascular Surgery) and planned for surgery taking all due precautions and safety measures.
Dr Mangla added, “She tolerated the surgery quite well and post-operatively was managed with blood thinners. She was discharged with a largely uneventful recovery 7 days after surgery and is now recovering fast. Since IVC leiomyosarcomas are relatively uncommon tumours with very few reported cases in medical literature and in Delhi as well, this seems to be a one of a kind case that we have managed, to the best of our knowledge. Such a long segment of IVC replacement with a PTFE graft along with reimplantation of left renal vein into the IVC for such a tumour may very well have been done for the first time.”
Approximately 74% of leiomyosarcomas of the IVC affect women between 40 and 60 years of age. Surgical management of such cancers requires extremely advanced facilities and a multidisciplinary team approach. This was handled with perfection by the team at Max Hospital, Vaishali as they worked in tandem to ensure safe and complete surgical removal with good outcomes even in such a case of a large tumour requiring complex resections and reconstructions.