Surgical management of testicular cancer patients with complex postchemotherapy residual masses: Aachen University experience.

387 Background: Post-chemotherapy retroperitoneal lymphadenectomy (PC-RPLND) represents the treatment of choice in patients with residual masses following chemotherapy for advanced non-seminomatous testicular germ cell tumors (NSGCT). Involvement of the abdominal aorta, the inferior vena cava or the thoracic/lumbar spine are rare but need complete resection for curative intent. We report on our single center experience in the management of such complex cases. Methods: Between January 2009 and September 2014 post-chemotherapeutic retroperitoneal lymph node dissection (PCRPLND) was performed in 162 patients (pts) with advanced NSGCT. Fourteen pts (4.9%) fulfilled the criteria of a GTS: enlarging metastatic mass in the retroperitoneum or visceral organs during systemic chemotherapy with normalized or regredient tumor markers. In all cases of GTS a complete radical bilateral PCRPLND including the resection of adjacent visceral and vascular structures was performed. Results: Median patient age was 24.5 (18 to 52). All patients exhibited NSGCT with a good or intermediate prognosis according to IGCCCG; 10 and 4 patients presented with clinical stage IIC and III, resp. Median tumor diameter at time of surgery was 6.5 (3,0-35)cm. Tumor markers were normalized in 12 out of 14 patients and markers plateauted in 2 out of 14 patients. Tumor masses were localized in the retroperitoneum in 12 pts; two pts had additional pulmonary metastases which were resected in a second approach. Median time from start of chemotherapy to surgery was 4.8 (1.5 to 26.5) months Median surgical time was 265 (165 to 585) minutes, median blood loss 650 (450 to 2,000) ml. Four pts required resection of the inferior vena cava or abdominal aorta with implantation of a prosthetic graft; adjunctive nephrectomy was performed in three pts. After a median follow-up of 4.2 years two pts developed recurrent disease; the remainder are alive without evidence of disease. Conclusions: Involvement of vascular structures and/or bone is a rare phenomenom among pts with advanced NSGCT and necessitates complete surgical resection of all masses with curative intention. Due to the complex surgery, treatment should be performed at specialized centers.

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Prognostic clinical parameters to predict the necessity of reconstructive vascular surgery for patients who undergo postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) for advanced nonseminatous germ cell tumors (NSGCT).

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.7_suppl.229 ◽

2011 ◽

Vol 29 (7_suppl) ◽

pp. 229-229

Author(s):

A. Heidenreich ◽

M. Schrader ◽

K. Dieckmann ◽

C. Winter ◽

D. A. Pfister ◽

...

Keyword(s):

Inferior Vena Cava ◽

Vascular Surgery ◽

Abdominal Aorta ◽

Poor Prognosis ◽

Inferior Vena ◽

Mature Teratoma ◽

Vena Cava ◽

Complete Resection ◽

Tumor Diameter ◽

Residual Masses

229 Background: PC-RPLND remains an integral part of the multimodality treatment for advanced NSGCT. The need to resect and to replace the major retroperitoneal vessels must be known preoperatively to enable complete resection of the residual masses. Methods: PC-RPLND was performed in 411 patients with NSGCT and normalized (81%) or plateauing (19%) tumor markers following 3-4 cycles PEB/PEI. PC-RPLND was performed in 5 institutions with a variable surgical frequency of 14 to 158 PC-RPLNDs. Good, intermediate, and poor prognosis according to the IGCCCG criteria was identified in in 59.8%, 21.2%, and 19% respectively. Results: Resection of the inferior vena cava was performed in 28 (6.81%), resection of the abdominal aorta was necessary in 13 (3.16%) patients. In 29/41 (70.7%) adjunctive surgical procedures such as nephrectomy, small bowel resection, ureteral resection had to be performed to ensure complete resection of the residual masses. Histologically vital cancer or mature teratoma was identified in 78.1% of the resected vascular specimens. Mean time of surgery was 295 (243-615) Min., mean blood loss was 690 (350 – 3400) ml. Good prognosis was identified in 15.4%, intermediate and poor prognosis was present in 41%and 43.6%, resp. Of all 411 patients involvement of the major retroperitoneal vessels was found in 3.2%, 18.4% and 21.8% with good, intermediate, and poor prognosis, resp. The mean tumor diameter was 5.9 (1.0 – 32) cm for the entire cohort and 9.8 (4-32) cm for the cohort of patients with vascular surgery. Significant prognosticators to predict vascular involvement were identified by multivariate analysis: intermediate/poor prognosis, number of cycles of chemotherapy, tumor diameter > 14cm, circumferential encasement of > 50% of the vessel diameter. Conclusions: Complete resection of the inferior vena cava or the abdominal aorta during PC-RPLND is necessary in about 10% of patients. The identified predictors enable already preoperatively a risk adapted interdisciplinary approach for complete resection of the residual masses in an experienced centre. No significant financial relationships to disclose.

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A sling of a normal right inferior vena cava around the abdominal aorta

Surgical and Radiologic Anatomy ◽

10.1007/s00276-021-02693-x ◽

2021 ◽

Author(s):

Ali Devrim Karaosmanoglu ◽

Selin Ardali Duzgun ◽

Deniz Akata ◽

Mustafa Nasuh Ozmen ◽

Musturay Karcaaltincaba

Keyword(s):

Inferior Vena Cava ◽

Abdominal Aorta ◽

Inferior Vena ◽

Vena Cava

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Inferior Vena Cava (IVC) Wall Penetration by IVC Filter Detected Incidentally During Retroperitoneal Lymphadenectomy

Indian Journal of Surgical Oncology ◽

10.1007/s13193-021-01372-y ◽

2021 ◽

Author(s):

Anand Raja ◽

Kanuj Malik

Keyword(s):

Inferior Vena Cava ◽

Inferior Vena ◽

Vena Cava ◽

Ivc Filter ◽

Retroperitoneal Lymphadenectomy

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Abdominal aorta, inferior vena cava and their branches

Anaesthesia & intensive care medicine ◽

10.1016/j.mpaic.2007.03.013 ◽

2007 ◽

Vol 8 (6) ◽

pp. 253-254

Author(s):

Harold Ellis

Keyword(s):

Inferior Vena Cava ◽

Abdominal Aorta ◽

Inferior Vena ◽

Vena Cava

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Effect of Lateral Tilt Angle on the Volume of the Abdominal Aorta and Inferior Vena Cava in Pregnant and Nonpregnant Women Determined by Magnetic Resonance Imaging

Anesthesiology ◽

10.1097/aln.0000000000000553 ◽

2015 ◽

Vol 122 (2) ◽

pp. 286-293 ◽

Cited By ~ 65

Author(s):

Hideyuki Higuchi ◽

Shunichi Takagi ◽

Kan Zhang ◽

Ikue Furui ◽

Makoto Ozaki

Keyword(s):

Magnetic Resonance ◽

Inferior Vena Cava ◽

Abdominal Aorta ◽

Supine Position ◽

Inferior Vena ◽

Vena Cava ◽

Magnetic Resonance Images ◽

Mean Difference ◽

Lateral Tilt ◽

The Right

Abstract Background: Left-lateral tilt position is used to reduce assumed aortocaval compression by the pregnant uterus. Methods: Magnetic resonance images of 10 singleton parturients at full term and 10 healthy nonpregnant women were obtained for measurement of the abdominal aorta and inferior vena cava volume between the L1–L2 disk and L3–L4 disk levels in both the supine and left-lateral tilt positions (15°, 30°, and 45°) maintained by insertion of a 1.5-m-long polyethylene foam placed under the right side of the parturient’s body. Results: Aortic volume did not differ significantly between parturients and nonpregnant women in the supine position (12.7 ± 2.0 vs.12.6 ± 2.1 ml, mean ± SD; mean difference, –0.1; 95% confidence interval [CI], −2.0 to 1.9; P = 0.95). Inferior vena cava volume in the supine position was significantly lower in parturients than in nonpregnant women (3.2 ± 3.4 vs.17.5 ± 7.8 ml; mean difference, 14.3; 95% CI, 8.3–20.2; P < 0.001). Aortic volume in parturients did not differ among left-lateral tilt positions. Inferior vena cava volume in the parturients was not increased at 15° (3.0 ± 2.1 ml; mean difference, −0.2; 95% CI, −1.5 to 1.2; P > 0.99), but was significantly increased at 30° (11.5 ± 8.6 ml; mean difference, 8.3; 95% CI, 2.3–14.2; P = 0.009) and 45° (10.9 ± 6.8 ml; mean difference, 7.7; 95% CI, 2.2–13.1; P = 0.015). Conclusions: In parturients, the aorta was not compressed, and a 15° left-lateral tilt position did not effectively reduce inferior vena cava compression.

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