Abstract
Background
The potential for massive hemorrhage imposes additional challenge in the management of retroperitoneal tumors. This report details technical considerations for the management of upper retroperitoneal tumors using principles of liver transplantation.
Methods
A retrospective chart review of patients who underwent surgery for extensive retroperitoneal tumors using techniques for liver transplantation from December 2002 to November 2007 was done.
Results
Twenty-four patients (14 males and 10 females with a mean age 57 years) underwent major retroperitoneal surgery. Renal cell carcinoma was the most common tumor seen in 17 patients. Mean tumor dimension was 12.4 cm. Abdominal exposure was achieved via bilateral subcostal incision with upper midline extension. Right hepatic lobe mobilization and isolation from the inferior vena cava (IVC) was performed in 23 cases. Fourteen patients had IVC involvement by tumor thrombus, which was infrahepatic in six, retrohepatic in five, and intra-atrial in three patients. Tumor thrombus was removed by cavotomy in seven cases, resection and plasty in four cases, IVC graft reconstruction in two cases, and one patient required IVC and atrial graft reconstruction. Liver resection was needed in seven patients to achieve R0 resection. The Pringle maneuver was used in three patients; total liver vascular isolation with venovenous bypass was required in two cases, transdiaphragmatic intrapericardial IVC control in one case, and cardiopulmonary bypass in one patient. There was no intraoperative or postoperative mortality and mean length of stay was 13 days.
Conclusion
Liver transplantation surgical principles help achieve exposure and vascular control of major vascular structures that enable safe resection of these extensive retroperitoneal tumors.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Facciuto ME, Babu S, Marvin M et al (2004) Intrapericardial control of the inferior vena cava from the abdominal cavity. J Hepatobiliary Pancreat Surg 11:286–289
Kim HL, Zisman A, Han K et al (2004) Prognostic significance of venous thrombus in renal cell carcinoma: are renal vein and IVC involvement different? J Urol 171:588–591
Moinzadeh A, Libertino JA (2004) Prognostic significance of tumor thrombus level in patients with renal cell carcinoma and venous tumor thrombus extension: is all T3b the same? J Urol 171:598–601
Neves RJ, Zincke H (1987) Surgical treatment of renal cancer with vena cava extension. Br J Urol 59:390–395
Nesbitt JC, Soltero ER, Dinney CP et al (1997) Surgical management of renal cell carcinoma with inferior vena cava thrombus. Ann Thorac Surg 63:1592–1600
Cummings KB, Li WI, Ryan JA et al (1979) Intraoperative management of renal cell carcinoma with supradiaphgramatic caval extension. J Urol 122:829
Skinner DG, Pritchett TR, Lieskovsky G et al (1989) Vena caval involvement by renal cell carcinoma. Ann Surg 210:387–394
Attwood S, Lang DM, Goiti J et al (1988) Venous bypass for surgical resection of renal carcinoma invading the vena cava: a new approach. Br J Urol 61:402
Foster RS, Mahomed Y, Bihrle R et al (1988) Use of caval-atrial shunt for resection of a caval tumor thrombus in renal cell carcinoma. J Urol 140:1370
Novick AC, Cosgrove DM (1980) Surgical approach for removal of renal cell carcinoma extending into the vena cava and right atrium. J Urol 123:947
Novick AC, Kaye MC, Cosgrove DM et al (1990) Experience with cardiopulmonary bypass and deep hypothermic circulatory arrest in the management of retroperitoneal tumors with large vena cava thrombi. Ann Surg 212:472–476
Klein EA, Kaye MC, Novick AC (1991) Management of renal cell carcinoma with vena caval thrombi via cardiopulmonary bypass and deep hypothermic circulatory arrest. Urol Oncol 18:445–447
Stewart JA, Carey JA, McDougal WS et al (1991) Cavoatrial tumor thrombectomy using cardiopulmonary bypass without circulatory arrest. Ann Thorac Surg 51:717–722
Montie JE, El Ammar R, Pontes JE et al (1991) Renal cell carcinoma with inferior vena cava tumor thombi. Surg Gynecol Obstet 173:107–115
Kise Y, Takayama T, Yamamoto J et al (1997) Comparison between thoracoabdominal approaches in occurrence of pleural effusions after liver cancer surgery. Hepatogastroenterology 44:1397–1400
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Facciuto, M.E., Singh, M.K., Rocca, J.P. et al. Benefits of Liver Transplantation Surgical Techniques in the Management of Extensive Retroperitoneal Tumors. World J Surg 32, 2403–2407 (2008). https://doi.org/10.1007/s00268-008-9714-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-008-9714-6