Background : Radical resection remains the only potential cure in the management of Inferior vena cava (IVC) leiomyosarcomas with multivisceral resections often needed as indicated by tumour extension into adjoining organs.

Methods : Computed tomography of a 60-year-old lady revealed a 12 x 12 x 9.5 cm mass in the right supra-renal region infiltrating the IVC with intraluminal extension up to the hepatic venous confluence. The mass involved the right hepatic vein with infiltration of segment 7 of the liver and splaying of the right portal vein. Robust lumbar venous drainage from the infra-tumoral IVC was seen. En bloc IVC resection without reconstruction along with a right hepatectomy and right nephrectomy was performed via a right thoracoabdominal approach.

Results : After a Catell-Braasch maneuver, the surgery can be broadly divided into 4 major steps: 1) Right retroperitoneal mobilization of the tumour and right kidney with infra-tumoral IVC control; 2) Mobilization of the right liver with supra-hepatic IVC control; 3) Division of the right portal structures with right hepatectomy; 4) En bloc resection of the IVC tumour. Reconstruction of the IVC was not performed due to the presence of venous collaterals.2 Final histopathology showed a high-grade leiomyosarcoma with histologic organ invasion in the liver and right kidney with resected margins free of the tumour (R0).

Conclusions : Meticulous preoperative planning and expertise in liver resection and retroperitoneal surgeries facilitates such radical yet safe multivisceral resection for a large retro-hepatic IVC leiomyosarcoma without the need for a cardiopulmonary bypass.