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Related Experiment Videos

Vascular considerations in postchemotherapy. Retroperitoneal lymph-node dissection: Part II

J P Donohue1, J A Thornhill, R S Foster

  • 1Indiana University Medical Center, Department of Urology, Indianapolis 46202-5250.

World Journal of Urology
|January 1, 1994
PubMed
Summary

Retroperitoneal lymph-node dissection (RPLND) may necessitate aortic grafting in rare cases with bulky disease. Risk factors include tumor fixation and bowel injury, but aortic grafting is feasible and well-tolerated.

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Area of Science:

  • Surgical Oncology
  • Vascular Surgery
  • Gastrointestinal Surgery

Background:

  • Retroperitoneal lymph-node dissection (RPLND) is a critical procedure for managing certain cancers.
  • Complications involving the aorta and gastrointestinal tract can arise during or after RPLND, particularly with bulky disease.

Purpose of the Study:

  • To evaluate the incidence and management of aortic complications during postchemotherapy retroperitoneal lymph-node dissection (RPLND).
  • To identify risk factors for aortic rupture and aortoenteric fistula following RPLND.
  • To assess the feasibility and outcomes of aortic grafting in patients undergoing RPLND.

Main Methods:

  • Retrospective review of 710 patients undergoing RPLND between 1965 and 1992.
  • Analysis of cases requiring aortic replacement due to complications.

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  • Identification of risk factors such as tumor fixation and duodenal enterotomy.
  • Evaluation of elective aortic grafting in four cases.

    • Main Results:

    • Ten patients (1.4%) required aortic replacement, seven during and three postoperatively.
    • Extended subadventitial aortic dissection due to tumor fixation was the primary risk for aortic rupture.
    • Duodenal enterotomy or extensive bowel serosal violation increased the risk of aortoenteric fistula.
    • Elective aortic grafting in four patients resulted in no vascular or bowel complications.
    • Omental interposition was employed to mitigate fistula formation.

    Conclusions:

    • Aortic grafting is a feasible and well-tolerated procedure in select patients undergoing RPLND with high-risk factors.
    • Careful surgical technique and consideration of omental interposition can minimize vascular and bowel complications.
    • Prospective aortic grafting may be indicated in cases with significant tumor fixation or extensive bowel manipulation.