Surgical Technique of Removal of Inferior Vena Cava Leiomyosarcoma Extending into the Right Atrium without Deep Hypothermic Circulatory Arrest

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Abstract
Leiomyosarcoma of the inferior vena cava is a rare tumor with potential for significant morbidity and mortality. Surgical extirpiration remains the optimal treatment choice. A case of caval leiomyosarcoma with right atrial extension is presented with management techniques and literature review. A 54 year old woman with constitutional symptoms was found to have advanced caval leiomyosarcoma with atrial extension. Surgical excision was performed without deep hypothermic circulatory arrest (DHCA), including right nephrectomy, adrenalectomy, and en-bloc resection of the vena cava along with Gore-Tex interposition graft. There were no operative complications. The patient was extubated on postoperative day one. Renal function remained normal. Final pathology was high grade leiomyosarcoma. Margins were negative. The patient is well at latest follow up. Resection of extensive caval leiomyosarcoma allows the best chance of cure and is possible without DHCA. Perioperative planning and coordination and adherence to oncologic techniques is critical.