Retroperitoneal lymph node dissection for testicular cancer in a patient with a double inferior vena cava

Abstract

Introduction A double inferior vena cava is a rare anomaly with an incidence ranging from 0.3% to 3.0%. In patients with a double inferior vena cava, it is important to understand the precise anatomy and possible irregular lymph node flow when performing surgery for malignancies. Case presentation A 60‐year‐old man with a non‐seminoma was referred to our hospital after left high orchiectomy. Computed tomography revealed a double inferior vena cava and swollen masses in the para‐aortic region. After four cycles of chemotherapy with etoposide and cisplatin, retroperitoneal lymph node dissection was safely performed with a modified template extended to the right side of the paracaval region by referring to three‐dimensional images created by SYNAPSE VINCENT® software. Conclusion Preoperative three‐dimensional images were useful to understand this patient’s unusual and complicated anatomical positions.

Retroperitoneal lymphoma with double inferior vena cava shown using a 3D visualization model: A case report and literature review

“…Therefore, in the present report, based on the patient's CT data, a 3D model was reconstructed using 3D visualization software, which enabled multistage fusion visualization of the retroperitoneal tumor, blood vessels and organ tissues. Previous reports on double IVC occasionally use 3D reconstruction images (14,25). The present report utilized a 3D reconstruction model of the retroperitoneal lymphoma with double IVC, which to the best of our knowledge, has not been reported previously.…”

“…Lucas (34) reported the first case of congenital IVC duplication in 1916. IVC malformations are rare, with the most common type being double IVC, occurring mainly due to abnormalities during embryonic development (25). The venous system originates from three symmetrically paired veins, namely the cardinal veins, umbilical veins and vitelline veins, all of which are formed during weeks 1-4 of embryonic development (26).…”

“…A previous study showed that misdiagnosis of a double IVC caused surgical confusion between the LIVC and the left gonadal vein, resulting in the severing of the LIVC during radical nephroureterectomy (24). Because the left gonadal vein develops from the left subcardinal vein, the LIVC runs along the medial side of the left gonadal vein, which increases the risk of misidentification between the left gonadal vein and LIVC (25). To avoid such misdiagnosis, operators are advised to probe the distal vein during the operation to confirm the type of vein.…”

Double inferior vena cava in retroperitoneal surgery for testicular cancer

“…Durante las cirugías retroperitoneales en urología, es poco común el hallazgo de malformaciones anatómicas de la vena cava inferior. (4) Reconocer esta variante anatómica representa parte de la evaluación preoperatoria completa, ya que, los detalles de la anatomía es paso importante para la orientación del lugar de intervención quirúrgica. (5)…”