Precaval recurrent endometrial cancer treated with en-bloc resection of the inferior vena cava and reconstruction using bovine pericardium : a case report and review of the literature

The majority of recurrent endometrial cancer after primary treatment present with both local and distant disease (Legge et al., 2020). While the role of cytoreductive surgery in recurrent endometrial cancer remains controversial, a meta-analysis noted that complete cytoreduction to no gross residual disease improved overall survival in selected subsets of patients (Barlin et al., 2010). Excision of para-aortic nodal disease with a negative margin is complicated by the need for resection of vascular structures to ensure clearance of the tumor with the risk of significant hemorrhage. Previous reports on en-bloc resection of the inferior vena cava (IVC) in oncology have included primary approximation of the vessel wall, ligation of the IVC, vascular reconstruction using autologous and synthetic grafts (Kato et al., 2015; Morris et al., 2019; Nakamura et al., 2014; Uccella et al., 2010). Bovine peri- cardium (BP), a novel material comprising a collagen matrix in a glutaraldehyde solution, has been used for IVC reconstruction in patients with upper gastrointestinal and renal clear cell cancer (Morris et al., 2019). This however has not previously been described in patients with gynecologic cancer. We present a case of para-aortic and precaval recurrent endometrial cancer treated with en-bloc resection of the IVC and reconstruction using a tabularized bovine pericardial graft.