Does Retroperitoneal Lymphadenectomy For Testicular Germ Cell Tumor Require a Different Approach in the Presence of Horseshoe Kidney?

Abstract

Purpose: We report our management of stage II testicular nonseminomatous germ cell tumor in 2 patients with horseshoe kidney and discuss the technical challenges posed by this renal fusion anomaly. The embryology and clinical anatomy of horseshoe kidney are discussed with particular reference to the anomalous vascular pattern and routes of testicular lymphatic drainage in this setting. Modifications and innovations of the standard technique of retroperitoneal lymphadenectomy in the presence of horseshoe kidney are discussed in light of our experience with these patients at 2 major tertiary care cancer centers. The significance of contemporary advanced noninvasive radiological techniques, such as helical computerized tomographic angiography with digital 3-dimensional reconstruction and magnetic resonance angiography, in the surgical planning and safe performance of surgery is emphasized.Materials and Methods: Two young male patients treated at 2 major American teaching hospitals who had coexistent stage II testicular nonseminomatous germ cell tumor and horseshoe kidney underwent salvage retroperitoneal lymph node dissection.Results: There was no evidence of recurrence in these 2 patients 12 and 15 months after surgery, respectively.Conclusions: Horseshoe kidney poses special technical problems during retroperitoneal lymphadenectomy for testicular tumors due to anomalous renal and intra-abdominal vascular patterns. Helical computerized tomography angiography is useful for meticulous surgical planning and the safe performance of surgery in this setting.

Successful para‐aortic lymph node dissection for endometrial cancer with horseshoe kidney: A case report and review of the literature

“…In fact, presence of venous anomalies was reported to be associate with significant venous hemorrhage in patients with abdominal aortic aneurysm . The venous anomalies associated with HSK have been summarized Table . In patients with HSK, the incidence of anatomical variations of the IVC, including double IVC, left IVC and azygos continuation IVC is higher than the incidence in the general population .…”

Inferior vena cava prosthetic replacement in a patient with horseshoe kidney and metastatic testicular tumor: technical considerations and review of the literature

“…In 90% of cases, the kidneys are fused at the lower poles, either symmetrically (midline fusion) or asymmetrically (L-shaped fusion) [16]. …”

“…The association between non-seminomatous GCT and horseshoe kidney is a rare event and is seen in about 1.3% of patients requiring retroperitoneal lymph node dissection [16]. To our knowledge, no cases have been reported in which replacement of the IVC was also necessary.…”

“…As described by Evans et al [16] and Sogani et al, [19] retroperitoneal lymph node dissection in patients with horseshoe kidney demands scrupulous preparation because of the added complexities arising from the vascular abnormalities associated with this congenital disorder. Added to this is the need to avoid resecting the isthmus as it is often composed of functional renal parenchyma and is therefore richly vascularized.…”