Multidisciplinary surgery for intravenous leiomyomatosis with inferior vena cava and/or intracardiac extension: a case series

Objective The aim of this study was to explore the clinical characteristics, multidisciplinary treatment experience of patients with intravenous leiomyomatosis with inferior vena cava and/or intracardiac extension and propose several surgical tips. Methods A retrospective analysis was conducted on the clinical data of 5 patients who were diagnosed with intravenous leiomyomatosis accompanied by inferior vena cava or intracardiac extension between January 2016 and December 2024. The data included demographics, imaging findings, multidisciplinary collaboration, surgical details and outcomes. Results The median patient age was 46.0 (41.0–51.5) years. All patients had a history of uterine fibroids or hysterectomy related to uterine fibroids. The most common symptoms included pelvic and/or intracardiac masses (80%), and abdominal distension (20%). All patients had inferior vena cava and iliac vein tumors, 3 (60%) patients had concomitant intracardiac tumors, and 1 (20%) patients had ovarian vein masses. All patients underwent a one-stage surgery, during which the pelvic and vascular/right atrial tumors were completely removed. The volume of blood loss during surgery was 800 (450–4,600) mL. Postoperative complications included pulmonary/pelvic infections (60%), incomplete intestinal obstruction (20%), and lower extremity and iliac vein thromboses ( n = 1, 20%). The median follow-up time after surgery was 30 (14–74) months, and no recurrence was observed. Conclusions Intravenous leiomyomatosis involving the inferior vena cava or heart is relatively rare. Surgery for this type of patient is difficult and may result in significant bleeding. Accurate preoperative evaluation, multidisciplinary treatment, and relevant surgical techniques are crucial for complete tumor resection.