Retroperitoneal lymph node dissection with concomitant IVC thrombectomy, caval wall resection, and grafting for metastatic NSGT

Hakky, Tariq S.; Kim, Timothy; Rodríguez, Alejandro; Armstrong, Paul A.; Mangar, Devanand; Spiess, Philippe E.

doi:10.1590/s1677-55382012000100020

Cited by 3 publications

(3 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, the defect of the cava wall was not large, so use of the artificial vascular patch was not necessary. There have been previous reports of open series [25]; however, there have been no reports of robotic IVC thrombectomy for testicular cancer vena cava tumor thrombus.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted laparoscopic retroperitoneal lymph node dissection with concomitant inferior vena cava thrombectomy for metastatic mixed testicular germ cell cancer: a case report

et al. 2019

View full text Add to dashboard Cite

Background The robot-assisted laparoscopic management of post-chemotherapy retroperitoneal metastasis and inferior vena cava tumor thrombus secondary to testicular cancer is a challenging task for urologists. Case presentation A pathological examination of a 36-year-old Caucasian man who had undergone a right radical orchiectomy showed mixed testicular germ cell cancer (70% embryonal cancer and 30% seminoma); he had undergone four prior courses of cisplatin, etoposide, and bleomycin chemotherapy and was found to have residual retroperitoneal enlarged lymph nodes close to the right renal hilum and a 9.8 cm inferior vena cava tumor thrombus (pT1, N2, M1, S2). Pre-surgical three-dimensional image reconstruction was performed based on contrast computed tomography data. The inferior vena cava tumor thrombus was found in the vena cava at the level of the celiac trunk and the inferior mesenteric artery. Our patient accepted treatment with robot-assisted laparoscopic retroperitoneal lymph node dissection with concomitant inferior vena cava thrombectomy and cava reconstruction on September 12, 2018. During the procedure, a drop-in robotic ultrasound probe was used to define the thrombus. Vena cavoscopy using a flexible ureteroscope found that the tumor thrombus adhered to the cava wall in all directions. The tumor thrombus was dissected free from the inferior vena cava lumen, and vena cava reconstruction was achieved using the da Vinci™ Si HD surgical system. The operative time was 550 minutes. The intraoperative estimated blood loss was 2300 ml. Intraoperative blood transfusions consisted of 10 units of red blood cells (Clavien-Dindo grade II). No Clavien-Dindo grade III or above perioperative complications occurred. The length of hospital stay was 7 days. Pathology revealed no viable cancer cells in any of the residual lymph node tissues or in the vena cava tumor thrombus. Conclusion This is the first case of robot-assisted laparoscopic retroperitoneal lymph node dissection with concomitant inferior vena cava thrombectomy and reconstruction for metastatic mixed testicular germ cell cancer published to date. This complicated surgical procedure was facilitated by the innovative usage of three-dimensional image reconstruction for defining the vena cava tumor thrombus, a robotic ultrasound probe for intraoperatively defining the vena cava tumor thrombus, and vena cavoscopy using a flexible ureteroscope.

show abstract

Section: Discussionmentioning

confidence: 99%

Robot-assisted laparoscopic retroperitoneal lymph node dissection with concomitant inferior vena cava thrombectomy for metastatic mixed testicular germ cell cancer: a case report

et al. 2019

View full text Add to dashboard Cite

show abstract

“…There were no graft-related complications in the patients who had graft replacement following vascular resection. 5 Similarly, Hakky et al 6 have reported a PC-RPLND with IVC thrombectomy, caval wall resection and grafting for metastatic NSGCT with minimal post-operative morbidity.…”

Section: Discussionmentioning

confidence: 99%

“…2 There have been anecdotal reports of these complex procedures being performed with few complications. 5,6 In our report, we describe the performance of such a complex procedure in a case of a PC residual lymph node mass in the retroperitoneum with 360-degree aortic encasement and involvement of the left renal hilum. Though a left nephrectomy had to be performed in this case, the aorta and IVC were preserved with complete macroscopic clearance of the metastatic mass.…”

Section: Discussionmentioning

confidence: 99%

Retroperitoneal lymph node dissection in post-chemotherapy residual mass with 360-degree involvement of the aorta

Regmi

Seth

Choudhary

et al. 2013

Journal of Clinical Urology

View full text Add to dashboard Cite

Post-chemotherapy retroperitoneal lymph node dissection in cases with encasement of major vessels is a formidable surgery. A 25-year-old man presented to us after a right high inguinal orchidectomy that showed a mixed germ cell tumor with predominant embryonal cell carcinoma elements. Following four cycles of bleomycin, etoposide and cisplatin (BEP), the serum markers had normalized but a large retroperitoneal mass predominantly on the left side encasing the large vessels including the left renal hilum persisted. A thoraco-abdominal approach was taken and the supraceliac aorta was defined, and the large mass encasing the left renal hilum was excised along with a left nephrectomy. The preaortic mass was divided applying the "split and roll" technique and subsequently removed. The interaortocaval and the precaval regions were also subsequently cleared. The aorta and the IVC were preserved and cleared completely of the tumor mass. Post-chemotherapy large residual lymph nodes present a difficult challenge in managing testicular malignancies especially if they encase major vessels that need to be preserved. Careful approach to tumor resection and standard surgical principles for lymph node dissection need to be followed to ensure a successful outcome.

show abstract

Best Videos of the Year 2012: Awards Recognizing Contributions to our Field

Spiess

2013

Int. braz j urol.

View full text Add to dashboard Cite

Retroperitoneal lymph node dissection with concomitant IVC thrombectomy, caval wall resection, and grafting for metastatic NSGT

Abstract: We present the first surgical video of a post-chemotherapy RPLND with IVC thrombectomy, caval wall resection and grafting for metastatic NSGCT. The final pathology report of teratoma with no viable tumor highlights the local vascular invasive potential of such pathology.

Cited by 3 publications

References 0 publications

Robot-assisted laparoscopic retroperitoneal lymph node dissection with concomitant inferior vena cava thrombectomy for metastatic mixed testicular germ cell cancer: a case report

Robot-assisted laparoscopic retroperitoneal lymph node dissection with concomitant inferior vena cava thrombectomy for metastatic mixed testicular germ cell cancer: a case report

Retroperitoneal lymph node dissection in post-chemotherapy residual mass with 360-degree involvement of the aorta

Best Videos of the Year 2012: Awards Recognizing Contributions to our Field

Contact Info

Product

Resources

About