Tumors at the Aortoiliac/Inferior Vena Cava Bifurcation: Preoperative, Anesthetic, and Intraoperative Considerations

Abstract

Primary and recurrent retroperitoneal tumors can involve the aortoiliac vasculature. They are often considered inoperable or incurable because of the locally advanced nature of the disease or the technical aspects involved in safely resecting the lesion. Safe resection of these lesions requires experience and extensive preoperative planning for success. A retrospective database review of 76 patients with retroperitoneal tumors identified tumors involving major vascular structures in the abdomen and pelvis undergoing resection of tumor en bloc with the aortoiliac vasculature. Preoperative planning and intraoperative technical maneuvers are reviewed. Patients were followed until time of this report. Four patients with retroperitoneal tumors involving the aortoiliac vessels underwent surgery: two patients with sarcoma (one primary and one recurrent), one with metastatic renal cell carcinoma, and one with a paraganglioma. All patients had resection of the aorta and vena cava or the iliac artery and vein. Arterial reconstruction (anatomic or extra-anatomic) was performed in all cases. The patient with renal cell carcinoma also required venous reconstruction to support a renal autotransplant. Veno-venous bypass was required in one patient. Local control was achieved in 3 of 4 cases. Surgery for retroperitoneal tumors involving major vascular structures is technically feasible with appropriate planning and technique. Multiple disciplines are required, including general surgical oncology, vascular surgery, and possibly, cardiothoracic surgery.

Management of retroperitoneal sarcoma involving the iliac artery: Single-center surgical experience

“…Intraoperative arteriography can not only block the blood flow of the artery to be ligated but also further specify the blood supply of the tumor. Complete surgical resection of RPSs invading vital organs and major vessels requires intraoperative cooperation, especially between vascular and urological surgeons[ 9 ].…”

Management of a Catecholamine-Secreting Paraganglioma Requiring Aortic Reconstruction

“…Concurrently, the importance of perioperative invasive monitoring and aggressive pharmacologic cardiovascular management cannot be overstated. 10 Several reports document preoperative chemotherapy and/ or radiation therapy conferring an advantage of shrinking the tumor. 11 Decreasing the size of the tumor may limit the en bloc resection; however, the inflammatory changes associated with the irradiated retroperitoneum may add to the difficulty of the resection.…”