Surgery for Retroperitoneal Tumors Involving Major Abdominal Vessels

Abstract

Major retroperitoneal vessels include the abdominal aorta and its major branches, namely, the common external iliac artery, renal artery, celiac artery, and superior mesenteric artery, as well as the inferior vena cava and its main tributaries, namely, the common external iliac vein and renal vein. Retroperitoneal tumors (RPTs) often invade the major vessels by pushing, wrapping, or even growing into them. For RPTs invading major vessels, surgeons often give up complete resection as they worry about causing damage to vessels infiltrated or wrapped by tumors during the separation. Vascular injury may result in uncontrolled heavy bleeding and is regarded as a contraindication to RPT surgery. With advances in surgical techniques, combined resection of major involved vessels (with or without vascular grafts) in RPT surgery has become an increasingly common avenue to significantly improve the successful rate of tumor resection. Preoperatively comprehensive evaluation of RPTs involving major blood vessels and surrounding organs is essential to a successful operation. B-ultrasound, enhanced CT, and MRI can clearly display the location, size, shape of the tumor, and surrounding organ involvement, particularly the relationship between the tumor and major vessels (such as the abdominal aorta, inferior vena cava, renal artery, iliac artery, superior mesenteric artery, and portal veins); the displacement, compression, or wrapping of blood vessels by the tumor; as well as tumor thrombus within the blood vessels. Preoperative angiography combined with embolization can be used to determine the relationship between the tumor and blood vessels and significantly reduce blood loss intraoperatively by decreasing the blood supply to the tumor.