Venous resection in urological surgery

Area of Science:

• Vascular Surgery
• Surgical Oncology
• Anatomy

Background:

• Tumor removal in the retroperitoneum and pelvis may necessitate the resection or ligation of major venous structures.
• A thorough understanding of venous anatomy and collateral drainage is essential for surgical planning.

Purpose of the Study:

• To provide an overview of retroperitoneal, pelvic, and mesenteric venous anatomy and collateral pathways.
• To review major veins that can be safely resected or ligated during oncologic surgery.

Main Methods:

• Comprehensive review of anatomical texts.
• Directed MEDLINE literature search focusing on venous anatomy and surgical resection.
• Emphasis on collateral blood flow and post-resection sequelae.

Main Results:

• The infrarenal inferior vena cava, iliac veins, left renal vein, lumbar veins, inferior mesenteric vein, and splenic vein are amenable to resection or ligation without reconstruction.
• Resection of the right renal vein typically leads to renal failure.
• The portal vein requires reconstruction if resected; reconstruction can utilize autologous or synthetic grafts.

Conclusions:

• Most major abdominal veins can be safely resected or ligated with minimal adverse effects.
• Knowledge of venous anatomy and collateral circulation is imperative for minimizing intraoperative and postoperative complications in oncologic resections.