Fascio-peritoneal patch repair of the IVC: a workhorse in search of work?1

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Abstract
A 52-year-old man with a history of nephrolithiasis presented with 2 years of intermittent right flank discomfort. This was a dull pain with no obvious initiating or alleviating factors. His physical examination, laboratory tests, abdominal x-rays, and IVP were all unrevealing. An ultrasound demonstrated a large mass adjacent to the right kidney. Subsequent CT scanning showed that this mass extended to the right lobe of the liver and encroached on the IVC, portal vein, and right hepatic vessels. He underwent exploratory laparotomy at a local hospital, where the tumor was deemed unresectable. An incisional biopsy revealed high-grade leiomyosarcoma. He presented to Memorial Sloan-Kettering Cancer Center for definitive management of this difficult problem.