Technique and Intraoperative Strategy for Circumferential Resection of Perirenal Inferior Vena Cava with Bilateral Renal Vein Reconstruction

Background: Primary sarcomas involving the inferior vena cava (IVC) are rare, constituting less than 1% of soft tissue sarcomas. Dedifferentiated liposarcomas affecting the perirenal IVC with bilateral renal vein involvement represent an exceptional surgical challenge. Case Report: This is a single-center case study describing the surgical approach, intraoperative decision-making, and postoperative management of a patient undergoing circumferential resection of the perirenal IVC with bilateral renal vein reconstruction using prosthetic grafts. Results: We report the case of a 32-year-old male with a history of treated Hodgkin’s lymphoma who was diagnosed with a retroperitoneal dedifferentiated liposarcoma encasing the infrahepatic IVC and both renal veins. Imaging revealed a metabolically active lesion abutting critical vascular and visceral structures. The patient underwent en bloc resection of the tumor and involved vasculature, preceded by bilateral renal vein reconstruction using Y-shaped 8 mm Dacron grafts to preserve renal perfusion. Key steps included caudate lobe mobilization, bilateral renal hilar dissection, end-to-side anastomosis of the left renal vein to the IVC, and reimplantation of the right renal vein into the graft limb. The IVC was divided and reconstructed following stable preload confirmation. The procedure lasted 12 hours with 1000 mL blood loss. Postoperative recovery included transient renal dysfunction, which resolved with supportive care. Histopathology confirmed high-grade dedifferentiated liposarcoma with negative margins. Conclusion: This case demonstrates that bilateral renal vein reconstruction using a Y-graft is feasible and effective in achieving oncologic and functional outcomes in retroperitoneal sarcomas involving the IVC. Meticulous anatomical planning and multidisciplinary collaboration are essential to the success of such complex vascular resections.