LETTER TO THE EDITOR
|Year : 2018 | Volume
| Issue : 3 | Page : 264
Primary leiomyosarcoma of the inferior vena cava
Vipul D Yagnik
Department of Surgical Gastroenterology, Ronak Endo-Laparoscopy and General Surgical Hospital, Patan, Gujarat, India
|Date of Web Publication||6-Jun-2018|
Vipul D Yagnik
77, Siddhraj Nagar, Rajmahal Road, Patan - 384 265, Gujarat
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Yagnik VD. Primary leiomyosarcoma of the inferior vena cava. J Min Access Surg 2018;14:264
I read the article, titled, 'Laparoscopic excision of leiomyosarcoma of inferior vena cava' by Suryawanshi and Agrawal, which was published in your esteemed journal, with great interest. I have a few comments to make regarding the article, which will help us, and the field in general, to better understand the resection of leiomyosarcomas in the inferior vena cava (IVC).
The authors stated, 'an international IVC leiomyosarcoma registry established in 1992 collected only 300 cases till date'. As the article was a case report, updated information on the number of cases involving leiomyosarcoma of the IVC would be greatly appreciated. On a careful search of the English literature, approximately 700 cases of primary leiomyosarcoma of the IVC were found to be reported till date. Hence, the data mentioned in the article may be out-dated and may require revision.
The authors also mention that the first case of leiomyosarcoma of the IVC was reported in 1996. This information is inaccurate as the first description of primary leiomyosarcoma of the IVC was provided by Perl in 1871 (DOI: 10.1007/BF01957198). The first surgical resection of this condition was described in 1928 by Melchior.
The authors performed total excision of a tumor without compromising the IVC lumen. In my humble opinion, partial resection of the IVC may lead to increased risk of tumor recurrence and an inadequate resection margin. It has been suggested that patients with leiomyosarcoma of the IVC should undergo complete resection of the portion of the IVC where the tumor is present. In the case description, it was mentioned that total excision of the tumor was performed. However, in the discussion the authors' state that radical excision was performed through laparoscopy. I would like to point out that the two processes are quite different from one another. Total excision of the tumor involves the complete resection of the tumor. In contrast, radical excision involves the removal of the primary tumor and a large amount of surrounding healthy tissue as well as lymph nodes through open surgery to not only ensure local control but also prevent the spread of the tumor through the lymphatic system. Radical surgery is associated with better long-term outcome.
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| ¤ References|| |
Suryawanshi PR, Agrawal MM. Laparoscopic excision of leiomyosarcoma of inferior vena cava. J Minim Access Surg 2017;13:303-5.
Mingoli A, Torre ML, Panzano C, Cirillo B. Primary leiomyosarcoma of the inferior vena cava. In: Azoulay D, Lim C, Salloum C, editors. Surgery of the Inferior Vena Cava. 1st
ed. Switzerland: Springer; 2017. p. 41-60.
Coughlin P. Vascular tumors. In: Thompson M, Boyle J, Brohi K, Cheshire N, Davies AH, Fitridge R, et al
., editors. Oxford Textbook of Vascular Surgery. 1st
ed. Oxford: Oxford University Press; 2016. p. 162-7.