Vascular anatomy and abnormalities of retroperitoneal pelvic and paraaortic area in relation to the radical oncogynecological surgery – individual experiences

Czech version

Authors: L. Minář; V. Weinberger; M. Felsinger
Authors‘ workplace: Onkogynekologické centrum, Gynekologicko-porodnická klinika LF MU a FN, Brno přednosta prof. MUDr. P. Ventruba, DrSc., MBA
Published in: Ceska Gynekol 2017; 82(2): 100-107

Overview

Objective:
The overview of vascular anatomy and abnormalities of retroperitoneal pelvic and paraaortic area in relation to the radical oncogynecological surgery.

Design:
Retrospective study.

Setting:
Gynecologic Oncology Center, Department of Obstetrics and Gynecology, Faculty of Medicine, Masaryk University and University Hospital Brno.

Material and methods:
The overview of visualized vascular anatomy of retroperitoneal pelvic, infrarenal suprapelvic and subhepatic area in relation to the radical oncogynecological surgery. Presentation of physiological vascular anatomy. Summary of the most common abnormalities and potential complications in terms of vascular injury. Basic management of these complications from the viewpoint of oncogynecologist.

Conclusion:
The perfect knowledge of vascular anatomy and its possible abnormalities has represented an absolute necessity for uncomplicated course and sufficient extent of radical surgery.

Keywords:
pelvic and paraaortic retroperitoneal area, vascular anatomy, vascular abnormality, vascular injury

Sources

1. Aletti, GD., Powless, C., Bakkum-Gamez, J., et al. Pattern of retroperitoneal dissemination of primary peritoneum cancer: basis for rational use of lymphadenectomy. Gynecol Oncol, 2009, 114, 1, p. 32–36.

2. Allen, C., Sauerland, E., Sievert C, Bardin J. Left-sided inferior vena cava. J Vasc Surg Venous Lymphat Disord, 2014, 2, 2, p. 206.

3. Aljabri, B., MacDonald, PS., Satin, R., et al. Incidence of major venous and renal anomalies relevant to aortoiliac surgery as demonstrated by computed tomography. Ann Vasc Surg, 2001, 15, 6, p. 615–618.

4. Babu, CS., Lalwani, R., Kumar, I. Right double inferior vena cava with preaortic iliac confluence – case report and review of literature. J Clin Diagn Res, 2014, 8, 2, p. 130–132.

5. Bubb, K., du Plessis, M., Hage, R., et al. The internal anatomy of the inferior vena cava with specific emphasis on the entrance of the renal, gonadal and lumbar veins. Surg Radiol Anat, 2016, 38, 1, p. 107–114.

6. Cibula, D., Abu-Rustum, NR., Benedetti-Panici, P., et al. New classification system of radical hysterectomy: emphasis on a three-dimensional anatomic template for parametrial resection. Gynecol Oncol, 2011, 122, 2, p. 264–268.

7. Čihák, R. Anatomie. 3. ed. Praha: Grada Publishing, 2016, 832 s.

8. Eitan, R., Abu-Rustum, NR., Walker, JL., Barakat, RR. Ligation of an anatomic variant of renal vasculature during laparoscopic periaortic lymph node dissection: a cause of postoperative renal infarction. Gynecol Oncol, 2003, 91, 2, p. 416–420.

9. Fotopoulou, C., El-Balat, A., du Bois, A., et al. Systematic pelvic and paraaortic lymphadenectomy in early high-risk or advanced endometrial cancer. Arch Gynecol Obstet, 2015, 292, 6, p. 1321–1327.

10. Gyimadu, A., Salman, MC., Karcaaltincaba, M., Yuce, K. Retroperitoneal vascular aberrations increase the risk of vascular injury during lymphadenectomy in gynecologic cancers. Arch Gynecol Obstet, 2012, 286, 2, p. 449–455.

11. Honma, S., Tokiyoshi, A., Kawai, K., et al. Preureteric inferior vena cava with possible rudiment of the proper inferior vena cava. Ann Anat, 2007, 189, 2, p. 191–195.

12. Chang, SJ., Ryu, HS. Laparoscopic para-aortic lymphadenectomy in endometrial cancer patient with left-sided inferior vena cava. Gynecol Oncol, 2012, 126, 1, p. 147–148.

13. Chiva, LM., Castellanos, T., Alonso, S., Gonzalez-Martin, A. Minimal macroscopic residual disease (0.1–1 cm). Is it still a surgical goal in advanced ovarian cancer? Int J Gynecol Cancer, 2016, 26, 5, p. 906–911.

14. Christison-Lagay, ER., Fishman, SJ. Vascular anomalies. Surg Clin North Am, 2006, 86, 2, p. 393–425.

15. Khamanarong, K., Woraputtaporn, W., Teerakul, S., et al. Left sided inferior vena cava: a case report. J Med Assoc Thai, 2010, 93, 8, p. 998–1000.

16. Klemm, P., Fröber, R., Köhler, C., Schneider, A. Vascular anomalies in the paraaortic region diagnosed by laparoscopy in patients with gynaecologic malignancies. Gynecol Oncol, 2005, 96, 2, p. 278–282.

17. Kose, MF., Turan, T., Karasu, Y., et al. Anomalies of major retroperitoneal vascular structure. Int J Gynecol Cancer, 2011, 21, 7, p. 1312–1319.

18. Lee, YS., Lee, JH., Choi, JS., et al. Accessory polar renal artery encountered in transperitoneal systemic laparoscopic paraaortic lymphadenectomy. Eur J Gynaecol Oncol, 2011, 32, 1, p. 87–90.

19. Li, J., Wu, X. Current strategy for the treatment of ovarian germ cell tumors: role of extensive surgery. Curr Treat Options Oncol, 2016, 17, 8, p. 44.

20. Oderich, GS., Panneton, JM., Hofer, J., et al. Iatrogenic operative injuries of abdominal and pelvic veins: a potentially lethal complication. J Vasc Surg, 2004, 39, 5, p. 931–936.

21. O‘Hanlan, KA. Comprehensive, therapeutic retroperitoneal pelvic and infrarenal aortic lymphadenectomy for advanced cervical carcinoma. Gynecol Oncol, 2013,130, 3, p. 634–635.

22. Shindo S., Kubota K., Kojima A., et al. Anomalies of inferior vena cava and left renal vein: risks in aortic surgery. Ann Vasc Surg, 2000, 14, 4, p. 393–396.

23. Sláma, J., Kocián, R. Technika pánevní a paraaortální lymfadenektomie. Čes Gynek, 2016, 81, 4, s. 253–264.

24. Strauss, A., Kuehnle, E., Hilpert, F., et al. Double inferior vena cava: a crucial finding complicating para-aortic lymphadenectomy. Eur J Obstet Gynecol Reprod Biol, 2011, 154, 2, p. 228–229.

25. Takagi, T., Tsujimoto, H., Torii, H., et al. Two-layer sheet of gelatin: A new topical hemostatic agent. Asian J Surg, 2016, Nov 2, pii: S1015-9584(16)30118-X.

26. Turyna, R., Kachlik, D., Kucera, E., et al. Complications inright-sided paraaortic lymphadenectomy: ventral tributaries of the inferior vena cava. J Anat, 2013, 223, 1, p. 69–73.

27. Uflacker, R. Atlas of vascular anatomy: an angiographic approach. Philadelphia: Lippincott Williams & Wilkins, 2007, 905 p.

28. Zivanovic, O., Sheinfeld, J., Abu-Rustum, NR. Retroperitoneal lymph node dissection. Gynecol Oncol, 2008, 111(2 Suppl), p. S66–69.