Perioperative Management Of Patient With IVC Leiomyosarcoma Resection: A Case Report

Research Article

Author(s): Andrea Letanovska*, Daniel Pindak, Maria Michalovova, Miroslav Jurik, Nina Novotna And Kristyna Adamikova

Published: December 12, 2024     DOI: 10.33552/ASOAJ.2024.05.000625

Abstract: Vascular Leiomyosarcomas Are Rare Soft Tissue Sarcomas, Primarily Affecting The Vasculature. Surgical Resection Remains The Cornerstone Of Treatment For This Condition And Is Currently The Only Therapeutic Approach With The Potential For Curative Outcomes. The Procedure Is Particularly Challenging In Cases Involving The Suprarenal Segment Of The Inferior Vena Cava (IVC), Where Vascular Reconstruction May Be Necessary. We Present A Case Of A 71-year-old Female With An IVC Sarcoma Located In The Suprarenal Segment, Who Underwent Successful Resection Without The Use Of Venovenous Intraoperative Bypass. The Procedure Involved Total Vascular Liver Exclusion, With Suprahepatic And Infrarenal IVC Clamping. We Also Report On The Hemodynamic Changes Observed During Hepatic Vein Manipulation And Clamping, Which Were Managed Pharmacologically. As Part Of Preoperative Management, The Patient Was Admitted To The Intensive Care Unit (ICU) And Subsequently Underwent Resection Of The Suprarenal IVC Segment, Along With Prosthetic Replacement, Right-sided Adrenalectomy, And Resection Of The First Segment Of The Liver. The Surgical Technique Is Detailed Later In The Manuscript. General Anesthesia Was Administered, Combining Intravenous Agents, Inhalational Anesthesia, And Epidural Analgesia. Throughout The Procedure, The Patient Experienced Significant Circulatory Instability, Requiring High Doses Of Vasoactive Agents And Catecholamines. Fluid And Vasoactive Drug Administration Were Titrated According To Semi-invasive Hemodynamic Monitoring, With Appropriate Blood Loss Replacement. At The Conclusion Of The Procedure, The Patient Was Transferred To The ICU For Continued Analgosedation And Mechanical Ventilation. In The Immediate Postoperative Period, Circulatory Stability Gradually Improved, And The Dosage Of Catecholamines Was Reduced. Given The Vascular Reconstruction, Continuous Anticoagulation Was Initiated, With Close Monitoring Of Coagulation Status. The Patient Experienced Diffuse Bleeding From Extensive Wound Areas, Likely Due To Adhesions From A Previous Failed Tumor Resection At Another Facility. As A Result, Three Subsequent Surgical Revisions Were Performed To Address The Bleeding, Although The Source Could Not Be Identified. During These Revisions, Temporary Administration Of Catecholamines Was Again Required. Ultimately, The Patient’s Condition Stabilized, And She Was Discharged On The 22nd Postoperative Day. This Represents Our First Experience In Slovakia With Perioperative Management Of A Patient Undergoing IVC Resection Without Extracorporeal Circulation Or Cardiopulmonary Bypass. The Management Of Such Cases Requires A Multidisciplinary Approach To Address Complex Complications And Improve Patient Survival Outcomes.

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