Safe dissection of high paraaortic lymph nodes superior to the renal vein in ovarian, primary peritoneal, or fallopian tube cancer by the “Komiyama's maneuver”, a modification of Kocher's maneuver

Komiyama, Shinichi; Manrai, Megumi; Takahashi, Rena; Takeya, Chiaki

doi:10.1016/j.ygyno.2017.02.015

Cited by 3 publications

(4 citation statements)

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“…Another disadvantage of adopting the Cattell-Braasch maneuver would be poor access to the suprarenal part of the abdominal aorta. When combined with the retroperitoneal incision from the aortic bifurcation along the inferior mesenteric vein to the ligament of Treitz, the Cattle-Braasch maneuver can provide a clear surgical field for suprarenal regions [14]. However, even this procedure does not allow access to the paravisceral region of the abdominal aorta, which can be better manipulated in the retroperitoneal approach.…”

Section: Discussionmentioning

confidence: 99%

Cattell-Braasch Maneuver: A Gadget to Manipulate Abdominal Aortic Aneurysm in a Patient with a Left-Sided Inferior Vena Cava

Tobe

Shirasu

Furuya

et al. 2019

Case Reports in Surgery

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A 76-year-old man was diagnosed with abdominal aortic aneurysm and a left-sided inferior vena cava. He underwent open surgery, and we employed the Cattell-Braasch maneuver to approach the abdominal aortic aneurysm from the right side. This enabled securing of the abdominal aortic aneurysm neck without mobilizing or dissecting the inferior vena cava. His postoperative course was uneventful. Although abdominal aortic aneurysm is typically approached from the left side in open surgery, approaching from the right side is beneficial in patients with abdominal aortic aneurysm and a left-sided inferior vena cava.

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Section: Discussionmentioning

confidence: 99%

Cattell-Braasch Maneuver: A Gadget to Manipulate Abdominal Aortic Aneurysm in a Patient with a Left-Sided Inferior Vena Cava

Tobe

Shirasu

Furuya

et al. 2019

Case Reports in Surgery

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“…About 5% of dysgerminoma occur in the phenotype of women with abnormal gonads. 7,8 Etiology is definitely unknown, but it is molecularly caused by the loss of function of the TRC 8 / RNF tumor suppressor gene 139. 4 Other causes of dysgerminoma are associated with Y chromosome abnormalities, 46XY, gonadal digenesis, mixed gonadal digenesis and reduced expression of the 16p protein gene due to the process of methylation by INK4 stimulating proliferation cell.…”

Section: Dysgerminomamentioning

confidence: 99%

“…However, 95% of women with dysgerminoma are genetically normal. 8,9 The incidence of ovarian tumors in pregnancy is 1 in 1000 pregnancies. While the incidence of ovarian cancer in pregnancy is even lower at 1 in 12,500-25,000 pregnancies.…”

Section: Dysgerminomamentioning

confidence: 99%

Inferior Vena Caval Syndrom in Paraaortic Metastastic Lession of Ovarian Dysgerminoma in Pregnancy Manage with Chemotherapy : a Case Report

Dewi

Muhammad

2020

AOJ

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Background : Inferior caval syndrom is a rare case. It can caused by compresssion of the tumor mass and paraaortic metastastasis lession of ovarian dysgerminoma. Dysgerminoma is one of the most common germ cell tumor, approximately 3-5% of all ovarian cancers.1 Rate of dysgerminoma metastasis to lymph node is around 28%. In all type of germ cell, dysgerminoma has higher insidens to lymph node metastasis compare to the others. The first level of lymph node metastsis is paraaortic lymph node. However, the insidens is unknown because there is no research about it yet.2,3 Dysgerminoma frequently in young age, less then 30 years. The exact etiology of dysgerminomas has not been determined, although recent molecular studies have implicated loss function of potential tumor suppressor gene TRC8/RNF139, abnormality of Y chromosome and gonadal dysgenesis.4 The problem arises when dysgerminoma is diagnosed in pregnancy woman as clinically has inferior vena cava syndrom sign and symptoms which acquired efective and fast management.Objective : Discuss inferior caval syndrom as effect of compression by tumor mass, metastasis tumor lesion and chemotherapy management in dysgerminoma with pregnancyCase Report : Patient 32 years old admitted to M. Djamil central general hospital referred from Batusangkar hospital with diagnosis G3P2A0L2 25-26 weeks of preterm pregnancy + dysgerminoma + obs. Dyspnue. Patient has symptoms dispnue, exercise intolerance, oedem extremity. Physical examination : blood pressure was 100/70 mmHg, HR 120 dpm, RR 35 bpm, T 37 C. Abdomen : uterus fundal was palpated 2 fingers above umbilical, ballotement (+), FHR 150-158 bpm. Genitalia : I V/U normal, vaginal bleeding (-), oedem extremity +/+. From ultrasonography found dysgerminoma ovary with compression to inferior vena cava and paraaortic metastatic. Patient was diagnosed with dispnue ec. inferior vena cava syndrom caused by compression of tumor mass + paraaortic lymph node metastasis lession of ovarian dysgerminoma on G3P2A0L2 25-26 weeks of preterm pregnancy. Patient was managed by BEP chemotherapy and symptom was dissapeared. Patient was admitted to M. Djamil again with 34-35 weeks of preterm pregnancy in active phase of first stage. Because obtructed of labor patient was decide to performed LSCS. Female baby was born 1800 gram, baby’s length was 45 cm, A/S 7/8, there is no congenital anomaly. Patient was followed up 1 month after surgery, there is no symptoms, but fromUltrasonograhy found corpus metastasis and CT scan impressed paraaortic lymph node metastasis + copus metastasis. Chemotherapy was continue one month after caesarean section. She was completed 4 cycles chemothrapy and the disease was cureable.Conclusion : Caval syndrom is a rare case and fatal, caused by direct compression of dysgerminoma mass and paraaortic lymph node metastasis. Diagnosis of dysgerminoma is anatomy pathology diagnose. Management of dysgerminoma is surgical staging and 3-4 cycle of chemoterapy with BEP regimen. Chemoterapy with BEP (Bleomisin-Etopuside-Cisplatin) is safe to performed at second trimester with inferior vena cava syndrom ec paraaorta lymph nodes metastasis. Dysgerminoma has a good response to chemotherapy with survival rate 96%Keywords: Caval syndrom, lymph node paraaortic metastatic

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“…Consequently, it is possible to expand the para-aortic region located cephalad to the renal artery, and it is easy to dissect the supra-renal PANs. Our method is a modification of Kocher's maneuver for duodenal mobilization and has been named Komiyama's maneuver for dissection of high para-aortic lymph nodes [3].…”

Section: Introductionmentioning

confidence: 99%

Metastasis to para-aortic lymph nodes cephalad to the renal veins in patients with ovarian cancer

et al. 2020

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Background: In patients with epithelial ovarian cancer, whether metastasis to para-aortic lymph nodes located cephalad to the renal veins (supra-renal PAN) should be classified as regional lymph node metastasis or distant metastasis remains controversial. This study was a preliminary retrospective evaluation of the pattern of supra-renal PAN metastasis in patients with epithelial ovarian cancer. Methods: The subjects were 25 patients with epithelial ovarian cancer, primary peritoneal cancer, or fallopian tube cancer who underwent systematic dissection of the para-aortic nodes, including the supra-renal PAN, and pelvic lymph nodes (PLN). Patient factors, perioperative factors, the number of dissected lymph nodes, and pathological lymph node metastasis were investigated. Results: Supra-renal PAN metastasis was found in 4/25 patients (16.0%). None of the 14 patients with pT1 or pT2 disease had supra-renal PAN metastasis, while 4/11 patients (36.4%) with pT3 or ypT3 disease had such metastases. None of the patients had isolated supra-renal PAN metastasis, while patients with supra-renal PAN metastasis also had multiple metastases to the infra-renal PAN and PLN. Conclusions: In patients with epithelial ovarian cancer, supra-renal PAN metastases might be considered to be distant rather than regional metastases. Further studies are needed to better define the clinical significance of supra-renal PAN metastasis.

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Safe dissection of high paraaortic lymph nodes superior to the renal vein in ovarian, primary peritoneal, or fallopian tube cancer by the “Komiyama's maneuver”, a modification of Kocher's maneuver

Cited by 3 publications

References 1 publication

Cattell-Braasch Maneuver: A Gadget to Manipulate Abdominal Aortic Aneurysm in a Patient with a Left-Sided Inferior Vena Cava

Cattell-Braasch Maneuver: A Gadget to Manipulate Abdominal Aortic Aneurysm in a Patient with a Left-Sided Inferior Vena Cava

Inferior Vena Caval Syndrom in Paraaortic Metastastic Lession of Ovarian Dysgerminoma in Pregnancy Manage with Chemotherapy : a Case Report

Metastasis to para-aortic lymph nodes cephalad to the renal veins in patients with ovarian cancer

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