Single-Stage Resection With Cardiopulmonary Bypass for Intravenous Leiomyomatosis With Cardiac or Great Vessel Extension

BACKGROUND Intravenous leiomyomatosis (IVL) is a rare smooth muscle neoplasm that, although histologically benign, can exhibit clinically progressive behavior with extension into great vessels and even the heart. This study aimed to evaluate the surgical outcomes of single-stage en bloc resection using cardiopulmonary bypass (CPB) in IVL patients presenting with intracardiac or major vascular extension. METHODS A retrospective study was conducted on patients with IVL treated at a single institution from 2019 to 2025. Demographic characteristics, operative techniques, and surgical outcomes were collected and analyzed. RESULTS The cohort consisted of 12 female patients with a mean age of 45.5 years. Among them, 7 patients diagnosed with IVL ultimately underwent surgical resection at our center. Tumor extension most involved the inferior vena cava and right atrium. Complete surgical resection was achieved in all operative cases through a single-stage en-bloc resection under CPB, with no perioperative mortality or major complications During a median follow-up of 28.3 months, no tumor-related deaths were observed, and one patient experienced recurrence (14.3%, 1/7). CONCLUSIONS Single-stage en-bloc resection with CPB for IVL extending into the heart or great vessels may be a safe and effective approach, with favorable short- and mid-term outcomes.