Resection Of Retroperitoneal Tumor Research Articles

Da Vinci robot-assisted retroperitoneal tumor resection in 105 patients: a single-center experience.

The Da Vinci Surgical System (DVSS) has the advantages of minimal invasion, rapid recovery, safety, and reliability. Although the DVSS has been widely used in various abdominal surgeries, descriptions of its use in robot-assisted retroperitoneal tumor resection (RRTR) are limited to case reports; large-sample systematic studies are lacking. The present study was performed to analyze the data of RRTR in our center, summarize our experience, and provide a reference for other retroperitoneal tumor centers. We retrospectively analyzed the clinical data of 105 patients who underwent RRTR at the Affiliated Hospital of Qingdao University from January 2015 to December 2022. Logistic univariate and multivariate analyses were performed to identify independent risk factors affecting RRTR. A receiver operating characteristic curve was used to find the cut-off value, which was then included in the logistic multivariate analysis for verification. Among the 105 patients, 87 successfully underwent RRTR (DVSS group) and 18 underwent conversion to open surgery (conversion group). There was no significant difference in sex, age, body mass index, history of abdominal surgery, or tumor location between the two groups (P > 0.05). The maximum tumor diameter [odds ratio (OR), 1.041; 95% confidence interval (CI), 1.015-1.067; P = 0.002] and pathological property (OR, 8.646; 95% CI, 2.370-31.544; P = 0.001) were independent risk factors for conversion to open surgery. Further analysis confirmed that the success rate of RRTR was higher for tumors with a maximum diameter of ≤64 mm and benign tumors. Based on our experience and statistical results, we believe that retroperitoneal tumors that meet the following criteria have a higher success rate of DVSS resection: maximum tumor diameter of ≤64 mm, benign tumors, the tumor has relatively clear boundary, no obvious invasion of surrounding tissues and organs, and no need for combined organ resection. RRTR is safe and effective in the treatment of RPT, and the clinical prognosis is similar to that of open surgery. The success rate of RRTR in patients with appropriate surgical indications for this procedure is higher.

Discordance of retroperitoneal and thoracic histologic findings in patients with metastatic germ cell tumors at postchemotherapy residual tumor resection

Introduction and objectivesPostchemotherapy residual tumor resection (PC-RTR) is an important part of the multimodal treatment for patients with metastatic germ cell tumors. Simultaneous retroperitoneal and thoracic metastases often require consecutive surgical procedures. This study analyzes the histologic findings after abdominal and thoracic surgery in order to tailor the sequence and intensity of surgery.Patients and methodsFrom a total of 671 PC-RTRs from 2008 to 2021 we analyzed 50 patients with stage III non-seminomatous germ cell tumor (NSGCT) who had undergone both retroperitoneal and thoracic postchemotherapy residual tumor resection after first-line and salvage chemotherapy.ResultsAll patients included had stage III NSGCT. 39 and 11 patients received first-line and salvage chemotherapy, respectively. 45 (90%) patients received retroperitoneal resection first, followed by thoracic surgery. Three patients (6%) underwent thoracic surgery before retroperitoneal surgery and two patients (4%) underwent simultaneous surgery. Overall, the histology of retroperitoneal and thoracic specimens was discordant in 23% of cases. After first-line chemotherapy, of fourteen patients with necrosis in retroperitoneal histology, four patients had vital carcinoma in lung histology. In patients with teratoma in the retroperitoneum, the thoracic findings were concordant in most cases (78%). When teratomatous elements were also present in the orchiectomy specimen, concordance was 100%. After salvage chemotherapy, the discordance rate was 55%.ConclusionThe data presented in this study underline that retroperitoneal residual masses with necrosis cannot reliably predict histologic findings of thoracic specimens. Patients with teratoma in the retroperitoneum have a high likelihood of teratoma in the thoracic specimen.

Inflammatory myofibroblastic tumor of the liver after adrenal neuroblastoma surgery: a case report

A boy aged 55 months was diagnosed with stage IV Neuroblastoma (NB) of the right adrenal gland 2 years ago. Preoperative chemotherapy was given and he was then treated with retroperitoneal tumor resection and lymph node dissection. After surgery, the children were transferred to the Hemato-Oncology Department for chemotherapy according to the high-risk group NB, with outpatient follow-up every 6 months. In the second postoperative year, abdominal computed tomography (CT) scan revealed a rounded hypodense area in the upper part of the right posterior lobe of the liver, with marked inhomogeneous enhancement in the venous phase after enhancement, which was surgically resected, and postoperative pathology confirmed inflammatory myofibroblastic tumor (IMT) of liver. The patient was not given any special treatment after surgery. In this study, whole transcriptome sequencing was performed on the postoperative specimen of adrenal NB and the specimen of IMT of liver. This unusual case emphasizes the need for close monitoring of second tumor development in NB survivors even in the absence of known predisposing factors.

Open versus robot-assisted retroperitoneal tumors resection involving inferior vena cava, abdominal aorta, and renal hilum: a comparative study

IntroductionSurgery is currently the only effective treatment for retroperitoneal tumors that do not involve any specific organ. The use of robots for removing both benign and malignant retroperitoneal tumors is considered safe and feasible. However, there is insufficient evidence to determine whether robotic retroperitoneal tumor resection (RMBRs) is superior to open retroperitoneal malignant resection (OMBRs). This study compares the short-term outcomes of robotic excision of benign and malignant retroperitoneal tumors with open excision of the same-sized tumors.MethodsThe study compared demographics and outcomes of patients who underwent robotic resection (n = 54) vs open resection (n = 54) of retroperitoneal tumors between March 2018 and December 2022. A 1:1 matching analysis was conducted to ensure a fair comparison.ResultsThe study found that RBMRs resulted in reduced operative time (OT), estimated blood loss (EBM), and postoperative hospital stay (PSH) when compared to OBMRs. Additionally, RBMRs reduced EBL, PHS, and OT for patients with malignant tumor involvement in major vessels. No significant differences were found in tumor size, blood transfusion rate, and morbidity rate between the RBMRs and OBMRs groups.ConclusionWhen comparing RMBRs to OMBRs, it was observed that RMBR was associated with lower (EBL), shorter postoperative hospital stays (PHS), and reduced operative time (OT) in a specific group of patients with both benign and malignant tumors.

Retrograde transvenous thoracic duct embolization for lymphatic leakage after retroperitoneal tumor and lymph node resection: a case report and literature review

BackgroundPostoperative lymphatic leakage is a complication of ineffective conservative treatment for retroperitoneal mass. Herein, we report a case of lymphatic leakage that arose after retroperitoneal tumor resection and that was treated with retrograde transvenous thoracic duct embolization.Case presentationA 28-year-old man with persistent abdominal pain was diagnosed with a large retroperitoneal metastatic tumor measuring 10 cm and a subdiaphragmatic lymph node originating from a testicular tumor. After high orchidectomy and neoadjuvant chemotherapy, the subdiaphragmatic lymph node and retroperitoneal tumor were resected together with the abdominal aorta; the latter was reconstructed using a prosthetic graft. Postoperatively, the patient developed chylothorax. No improvement was observed after conservative treatment that included fasting and somatostatin therapy. The leakage site could not be identified using antegrade lymphangiography of the bilateral inguinal lymph nodes, but was detected using retrograde transvenous lymphangiography. The leakage site was successfully embolized.ConclusionThis case report describes successful treatment with retrograde transvenous thoracic duct embolization for chylothorax following resection of a retroperitoneal tumor and lymph node. This approach is a less invasive and more effective mode of treatment for chylothorax and should be considered before surgical thoracic duct ligation when the leakage point cannot be identified using the antegrade approach.

The Role of Cardiovascular Surgeons in Oncovascular Surgery for Resection of Retroperitoneal Tumors: A Case Report

The Role of Cardiovascular Surgeons in Oncovascular Surgery for Resection of Retroperitoneal Tumors: A Case Report

Mixed reality in primary retroperitoneal tumour surgery: Evaluation of preoperative and intraoperative application value.

To evaluate the feasibility and application value of mixed reality technology (MR) in Primary retroperitoneal tumour (PRT) surgery. From 276 patients who underwent PRT resection at the First Affiliated Hospital of Xi'an Jiaotong University, we screened 46 patients who underwent MR-assisted retroperitoneal tumour resection and 46 patients who underwent tumour resection without MR assistance. The intraoperative and postoperative recovery of the patients in both groups were compared, and the reliability and validity of the application of MR were further examined using the Likert scale. There was a significant difference in the mean intraoperative bleeding volume between the two groups, but it was reduced in the MR group. The resultsof the Likert scale showed higher scores in the MR group than non-MR group. MR can be used to assist PRT resection and has great potential to improve the rate of complete retroperitoneal tumour resection.

Seminoma arising in splenogonadal fusion: a case report and literature review

BackgroundSplenogonadal fusion (SGF) is a rare congenital malformation in which the spleen is abnormally connected to the gonads or to the mesonephric derivatives. There is no obvious causality between SGF and testicular neoplasm. However, cryptorchidism, which is a well-known risk factor of testicular germ cell tumors, are the most frequent malformations associated with SGF. To our knowledge, there are only four reported cases of SGF associated with testicular neoplasm so far. Herein, we reported a patient of this condition, and briefly reviewed the related literature.Case presentationA 48-year-old man was diagnosed with bilateral cryptorchidism 30 years prior, and only underwent a right orchiopexy for the left testicle could not be explored during the operation. At that time, doctors failed to realize the possibility of SGF due to the lack of sufficient knowledge of this condition. This time, the patient was treated for a left abdomen mass that was diagnosed as stage III metastatic seminoma. Then, a right orchiectomy, robot-assisted laparoscopic left retroperitoneal tumor resection, and left retroperitoneal lymph node dissection was performed after four cycles of BEP (bleomycin + etoposide + cisplatin) systemic chemotherapy in our center. The final diagnosis of SGF was made by postoperative pathology. The patient was re-examined in our center at 3 months and 6 months after the operation, and no obvious abnormalities were found.ConclusionsSurgeons should always bear in mind the possibility of association between bilateral cryptorchidism and splenogonadal fusion to avoid malignant transformation caused by delayed treatment.

The Use of Extracorporeal Circulation to Facilitate the Resection of a Large Retroperitoneal Sarcoma With Major Vessel Involvement: A Single-Center Review of 20 Cases

To describe the introduction of extracorporeal corporeal oxygenation (ECMO) to facilitate the surgical resection of large retroperitoneal sarcomas involving major vessels and to report preliminary outcomes. A case series. At a tertiary university hospital and state sarcoma center. Patients undergoing retroperitoneal sarcoma resection requiring inferior vena cava (IVC) reconstruction between June 2018 and March 2022. ECMO for retroperitoneal tumor resection requiring IVC reconstruction. A total of 20 patients underwent ECMO-assisted retroperitoneal sarcoma resection and IVC reconstruction. The median age was 60.5 years (IQR 48-69); 15 women and 5 men. The median procedure and ECMO durations were 10.8 hours (IQR 8.5-12.4 hours) and 2.2 hours (IQR 62-218 minutes), respectively. The median intensive care unit and hospital lengths of stay were 4 days (IQR 3-5 days) and 21 days (IQR 14-31 days), respectively. All 20 patients received packed cell transfusions (median 8 per patient [IQR 4-14]); 11 patients required fresh frozen plasma, 6 required platelets, and 11 required fibrinogen supplementation. One patient required recombinant activated factor VII. Sixteen patients experienced acute kidney injury, with 12 patients progressing to chronic kidney disease. Three patients were required to return to the operating room within 7 days, with no returns within the first 24 hours. There was no in-hospital or 30-day mortality. Survival at 3 years was 84%. ECMO for resecting large retroperitoneal tumor resection was introduced successfully and facilitated satisfactory outcomes for many patients who might otherwise have been considered too high risk.

Pediatric patient-specific three-dimensional virtual models for surgical decision making in resection of hepatic and retroperitoneal tumors.

Typically, preoperative imaging is viewed in two dimensions (2D) only, but three-dimensional (3D) virtual models may improve viewers' anatomical perspective by permitting them to interact with the imaging through manipulating it in space. Research into the utility of these models in most surgical specialties is growing rapidly. This study investigates the utility of 3D virtual models of complex pediatric abdominal tumors for clinical decision making, particularly the decision to proceed with surgical resection or not. 3D virtual models of tumors and adjacent anatomy were created from CT images of pediatric patients scanned for Wilms tumor, neuroblastoma or hepatoblastoma. Pediatric surgeons individually assessed the resectability of the tumors. First, they assessed resectability using the standard protocol of viewing imaging on conventional screens and then reassessed resectability after being presented with the 3D virtual models. Inter-physician agreement on resectability for each patient was analyzed using Krippendorff's alpha. Inter-physician agreement was used as a surrogate for correct interpretation. Participants were also surveyed afterward on the utility and practicality of the 3D virtual models for clinical decision making. Inter-physician agreement when using CT imaging alone was "fair" (Krippendorff's alpha α = 0.399), while inter-physician agreement when using 3D virtual models increased to "moderate" (Krippendorff's alpha α = 0.532). When surveyed about model utility, all 5 participants considered them helpful. Two participants felt the models would be practical for clinical use in most cases, while 3 felt they would be practical for select cases only. This study demonstrates the subjective utility of 3D virtual models of pediatric abdominal tumors for clinical decision making. The models are an adjunct that can be particularly useful in complicated tumors that efface or displace critical structures that may impact resectability. Statistical analysis demonstrates the improved inter-rater agreement with the 3D stereoscopic display over the 2D display. The use of 3D displays of medical images will increase over time, and evaluation of their potential usefulness in various clinical settings is necessary.

Replantation of solitary kidney in a patient with giant primary retroperitoneal sarcoma

Background. Surgery for non-organ malignant retroperitoneal tumors poses a serious challenge. Long-term asymptomatic course of the disease leads to a delayed diagnosis, when tumors can reach massive size with potential involvement of adjacent organs and critical structures. In most cases, nephrectomy is often required during resection of retroperitoneal sarcomas. Recently, there has been growing interest in nephronsaving surgery for large retroperitoneal tumors.Description of the clinical case. A 70-year-old patient was admitted to Irkutsk Regional Cancer Center with right-sided giant primary retroperitoneal tumor and grade 1 hydronephrosis of solitary right kidney. The patient underwent extended resection of primary retroperitoneal tumor with right-sided hemicolectomy and nephradrenalectomy. Extracorporeal resection of the solitary kidney was then performed. After obtaining negative kidney smears (imprints), the kidney was replanted in the pool of right iliac vessels. No complications were observed in the postoperative period. Histopathology examination revealed was welldifferentiated liposarcoma. On follow-up examination 38 months after surgery, there were no signs of local tumor recurrence, and renal function was satisfactory.Conclusion. Extracorporeal resection of the kidney with heterotopic replantation is an effective nephron-saving method in surgery for primary retroperitoneal sarcomas. The patient’s solitary kidney with primary retroperitoneal sarcoma is an absolute indication for kidney’s saving, including the use of transplant technologies.

Thoracoabdominal Aortic Replacement Together with Curative Oncological Surgery in Retroperitoneal and Spinal Tumours

Malignancies with an extended encasement or infiltration of the aorta were previously considered inoperable. This series demonstrates replacement and subsequent resection of the thoracoabdominal aorta and its large branches as an adjunct to curative radical retroperitoneal and spinal tumor resection. Five consecutive patients were enrolled between 2016 and 2020, suffering from cancer of unknown primary, pleomorphic carcinoma, chordoma, rhabdoid sarcoma, and endometrial cancer metastasis. Wide surgical resection was the only curative option for these patients. For vascular replacement, extracorporeal membrane oxygenation (ECMO) was used as a partial left-heart bypass. The early technical success rate was 100% for vascular procedures and all patients underwent complete radical tumour resection with negative margins. All patients required surgical revision (liquor leak, n = 2; hematoma, n = 3; bypass revision, n = 1; bleeding, n = 1; biliary leak, n = 1). During follow-up (average 47 months, range 22-70) primary patency rates of aortic reconstructions and arterial bypasses were 100%; no patient suffered from recurrent malignant disease. Thoracoabdominal aortic replacement with rerouting of visceral and renal vessels is feasible in oncologic patients. In highly selected young patients, major vascular surgery can push the limits of oncologic surgery further, allowing a curative approach even in extensive retroperitoneal and spinal malignancies.

Application of 3D printing technology for pre-operative evaluation, education and informed consent in pediatric retroperitoneal tumors

To investigate usefulness of 3D printing for preoperative evaluations, student and resident education, and communication with parents or guardians of patients with pediatric retroperitoneal tumors. Ten patients planning retroperitoneal tumor resection between March and November 2019 were included. Preoperative computed tomography (CT) images were used for 3D reconstruction and printing. Surveyed items were understanding of preoperative lesions with 3 different modules (CT, 3D reconstruction, and 3D printing) by students, residents, and specialists; satisfaction of specialists; and comprehension by guardians after preoperative explanations with each module. The median age at operation was 4.2 years (range, 1.8–18.1), and 8 patients were diagnosed with neuroblastoma. The 3D printing was the most understandable module for all groups (for students, residents, and specialists, P = 0.002, 0.027, 0.013, respectively). No significant intraoperative adverse events or immediate postoperative complications occurred. All specialists stated that 3D printing enhanced their understanding of cases. Guardians answered that 3D printing were the easiest to comprehend among the 3 modules (P = 0.007). Use of 3D printing in treatment of pediatric patients with retroperitoneal tumors was useful for preoperative planning, education, and parental explaining with obtaining informed consents.

Retroperitoneal tumour resection in fifteen consecutive cases: Single centre experience.

Retroperitoneal tumours (RTs) in adults are a rare heterogeneous group of neoplasms arising from the retroperitoneal space. RTs'clinical manifestations are nonspecific and depend on their anatomical positioning and relation with bordering structures. Our study aimed to retrospectively evaluate our patients' diagnosis, length of hospital stay, disease-free period and postoperative metastasis occurrence. From 2011 to 2019, fifteen suspected RT resections were performed at our centre. Retrospective analysis of patients' hospital stays, follow-up, histological and immunological tumour profile, and metastasis occurrence/ re-occurrence was performed. All of the 15 (100%) patients were males. The average age of our patients was 44 years (SD ± 11.2 years), average hospital stay was 7.4 days (SD±3.4 days) (Tab.1). All resected tumours underwent histological and immunological evaluation. Based on histological examination of the resected tumours, nonseminomatous germ cell tumours were present in 12 (80%) patients - including teratoma in 4 (26.6%) patients, seminoma in 2 (13.3%) patients, and malignant B-cell lymphoma in 1 (6.6%) patient. The average patient follow-up was 42.7 months (SD±31.4.9 months). Complete remission after the surgery was achieved in 11 (76.9%) patients, and 2 (13.3%) patients were lost in follow-up. RT is a rare heterogeneous group of neoplasm. The patient's prognosis dramatically depends on the type of tumour, metastasis occurrence and re-occurrence, and the surgeons' ability to resect the tumour completely.

Resection of retroperitoneal tumors with inferior vena cava involvement without caval reconstruction.

Retroperitoneal tumors with involvement of the inferior vena cava (IVC) often require resection of the IVC to achieve complete tumor removal. This study evaluates the safety and efficacy of IVC ligation without caval reconstruction. A retrospective chart review of patients who underwent IVC ligation(IVC-Ligation) and IVC resection with reconstruction (IVC-Reconstruction) at our institution between May 2004 and April 2021 was performed. Outcomes from the two surgical techniques were compared via univariate analysis using the Kruskal-Wallis test for continuous variables and Fisher's exact test for categorical variables. Forty-nineIVC-Ligation and sixIVC-Reconstruction surgeries were identified. There were no differences in baseline demographics, tumor characteristics, complication rates, postoperative morbidity, or overall 5-year survival between groups. IVC-Reconstruction patients were more likely to require intensive care unit admission (83% vs. 33%; p = 0.0257) and the IVC-Ligation cohort had a tendency to present with nondebilitating postoperative lymphedema (35% vs. 0%; p = 0.1615), which resolved for most patients. IVC-Ligation is a viable surgical option for select patients presenting with retroperitoneal tumors with IVC involvement and provides acceptable short- and medium-term outcomes.

En Bloc Resection of Right Renal Cell Carcinoma and Inferior Vena Cava Tumor Thrombus Without Caval Reconstruction: Is It Safe to Divide the Left Renal Vein?

IntroductionIt has been suggested that inferior vena cava (IVC) reconstruction following resection of retroperitoneal tumors with IVC tumor thrombus (TT) is not required when adequate collateral circulation is present. There are no reports evaluating mid-term effects on renal function in these patients. The purpose of this study was to assess renal function after en bloc resection of right renal cell carcinoma (RCC) with obstructing IVC TT and the possible risks that may arise after left renal vein division.Materials and MethodsA bi-institutional retrospective review was performed over a 15-year period, assessing patients with right RCC and obstructing level II–IV TT. All patients underwent extensive evaluation and cardiology clearance, and informed consent was obtained for right radical nephrectomy and thrombectomy with or without IVC reconstruction with possible cardiopulmonary bypass (CPB). Patient demographics, tumor characteristics, intraoperative factors, complications, length of stay, and patient survival were evaluated. Preoperative creatinine was recorded, as was creatinine on the day of discharge and at 6 and 12 months postoperatively.ResultsTwenty-two patients were included in the study. Median age at surgery was 62.5 (range: 45–79) years, and 19 (86%) of the patients were men. One patient (5%) had a level II thrombus, 14 patients (64%) had a level III thrombus (IIIa, n = 3; IIIb, n = 6; IIIc, n = 3; IIId, n = 2), and seven patients (32%) had a level IV thrombus. Intraoperatively, median estimated blood loss was 1.35 (range: 0.2–25) L. The median length of hospital stay was 11 (range: 5–50) days. Median preoperative creatinine was 1.20 (range: 0.40–2.70) mg/dl, and postoperatively, median creatinine was 1.3 (range: 0.86–2.20) mg/dl. Median creatinine levels at 6 months and 12 months postoperatively were 1.10 (range: 0.5–1.8) mg/dl and 1.40 (range: 0.6–2.0) mg/dl, respectively. Four patients died (range: 0.1–1.3 years), and median postoperative follow-up among the 18 ongoing survivors (at last follow-up) was 1.5 (range: 0.5–7.0) years.ConclusionsResection of right RCC with an obstructing level II–IV TT without reconstruction of the IVC appears to not have a significant adverse effect on mid-term renal function after division of the left renal vein.

Retroperitoneal lipoma in pregnancy: Between surgical intervention and postpartum deferral.

Timing of retroperitoneal tumor resection in pregnancy should be guided by patient symptoms, gestational age, and radiologic features to minimize potential maternal and fetal morbidity.

Clinical Experience and Management Strategy of Retroperitoneal Tumor With Venous Tumor Thrombus Involvement.

BackgroundThis study aims to report the surgical management, complications, and outcomes for patients with retroperitoneal tumor and venous thrombus.MethodsWe retrospectively analyzed 19 cases of retroperitoneal tumor with venous tumor thrombus from August 2015 to March 2021. A new tumor thrombus PUTH-RT grading system was proposed on the basis of the characteristics of the surgical techniques.ResultsTwo cases of PUTH-RT-1a, two cases of PUTH-RT-1b, six cases of PUTH-RT-2, six cases of PUTH-RT-3, and three cases of PUTH-RT-4 were included. Surgeries were successfully performed in all 19 patients. Among them, five cases (26.3%) were operated via a completely laparoscopic approach and 13 cases (68.4%) via an open approach. One case (5.3%) was converted from laparoscopic to open approach. Five cases (26.3%) experienced postoperative complications. All patients were followed for a median of 14 months. Cancer-associated death occurred in three cases. Distant metastases occurred in seven cases.ConclusionsWe propose a new tumor thrombus grading system based on the anatomical characteristics of retroperitoneal tumors with venous tumor thrombus. Retroperitoneal tumor resection and removal of venous tumor thrombi are safe and effective for the treatment of such diseases.

Five-year survival after retroperitoneal oncologic resection with and without vascular surgeon intervention.

Retroperitoneal tumor resection commonly disturbs major vessels; therefore, surgical teams can recruit vascular surgeons to prevent injuries and improve the prognosis of oncologic patients. The objective of the present study is to establish long-term survival after retroperitoneal tumor resection surgery with an emphasis on the potential impact of preventing or repairing major vessel injuries when tumors are adjacent to the aorta or vena cava. Retrospective case series including all cases of surgical removal of retroperitoneal tumors between 2007 and 2020 in a highly specialized hospital in Mexico City. Long-term survival was defined as 5 years after surgical intervention. Descriptive statistics, group-comparison tests, and regression analysis were performed using Stata 16. From a total of 70 cases, vascular injury occurred in 30 (42.8%) and the vascular surgeon intervened in 19 (27.1%) of them, 4 (21%) were performed by a vascular surgeon with planned intervention, and in 9 (47.3%) cases the vascular surgeon was called to join the surgery due to emergency. Intraoperative bleeding was 2-fold greater in the group with an emergent participation of vascular surgery in contrast with the planned intervention group (4, 235mL vs 2, 035mL, p = 0.04). The regression model revealed a significant association between the intervention of a vascular surgeon and long-term survival (OR 59.3, p = 0.03) after adjusting for sociodemographic and characteristics of oncologic nature. Planned intervention of vascular surgeons in retroperitoneal tumor resection may have a positive impact not only in trans-operatory period, but also on long-term survival.

Aorto-iliac paraganglioma: Case report and literature review.

IntroductionParaganglioma and pheochromocytoma are uncommon conditions that affect around 1.5–9 patients per million. The most frequent symptoms are headache, hypertension and diaphoresis; however, palpitations or tachycardia could be present. Malignancy is not frequent, and when is suspected, positron emission tomography (PET) should be performed. Surgery it's the gold standard treatment, with acceptable rates of morbidity and mortality.Presentation of the caseA 33-year-old woman presented to private practice with long-standing symptoms consisting of asthenia, adynamia, and sensation of palpable masses in the neck. Due to her medical history and imaging findings, urine metanephrines were obtained, showing high values of adrenaline 6.69 (μg/24 h), noradrenaline 130.09 (μg/24 h), dopamine 262.59 (μg/24 h). PET was performed to identify hyperfunctioning masses in other locations, finding bilateral carotid hypermetabolic masses and a nodular lesion anterior to the aortoiliac bifurcation, probably malignant. Laparoscopic retroperitoneal tumor resection was performed by a laparoscopic and metabolic surgeon, with intraoperative findings of a vascularized mass (30 × 25 mm) closely related to the left aortoiliac bifurcation and peritoneal fluid.DiscussionParagangliomas are rare tumors that frequently produce catecholamines with varied symptoms. Diagnosis requires patient history, laboratory studies including 24-hour urine-metanephrines and plasma metanephrine levels. Imaging such as CT, MRI and PET scan are necessary. Perioperative management needs to be performed and surgery is the basis of the treatment in patients with localized disease. Metastatic disease has a 50% mortality at 5 years and requires a different approach.ConclusionParaganglioma is a rare and complex entity that requires a multidisciplinary approach.