En Bloc Resection of Inferior Vena Cava Leiomyosarcoma with Prosthetic Caval Reconstruction and Renal Autotransplantation: A Case Report

Background: Inferior vena cava (IVC) leiomyosarcoma is a rare vascular malignancy for which complete surgical resection remains the only potentially curative treatment. Surgical management is technically demanding, particularly when the tumor involves the renal veins and retrohepatic IVC, requiring complex vascular reconstruction while preserving renal function. Case Presentation: We report the case of a 60-year-old woman with a localized high-grade IVC leiomyosarcoma involving the retrohepatic cava and both renal vein ostia, with cranial intraluminal extension toward the right atrium. Following multidisciplinary evaluation, the patient underwent en bloc tumor resection with reconstruction of the IVC using a 20mm ringed polytetrafluoroethylene (PTFE) graft. Left renal venous drainage was restored through prosthetic reconstruction using a tubular pericardial conduit anastomosed to the prosthetic graft, while renal function on the right side was preserved by renal autotransplantation into the right iliac fossa. Histopathological examination confirmed a high-grade leiomyosarcoma with negative surgical margins (R0 resection). Adjuvant chemotherapy with doxorubicin and dacarbazine was initiated but discontinued after two cycles because of cardiotoxicity. Fourteen months after surgery, the patient remains disease-free with preserved renal function. Conclusions: Radical resection combined with tailored vascular reconstruction remains the cornerstone of treatment for localized IVC leiomyosarcoma. When the renal veins are involved, combining prosthetic caval reconstruction with renal autotransplantation may represent a safe and feasible strategy to preserve renal function while achieving complete oncological resection.