Application of orthotopic autologous renal transplantation combined with inferior vena cava resection and reconstruction in retroperitoneal tumor_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

PANG Beichuan ^1,2 , ZHANG Na ³ , YANG Chong ^1,2 , LIAO Yubo ⁴ , HUANG Liang ⁴ , YANG Wenhao ^1,2 , YUAN Chengxiang ⁴ ,  ZHANG Yu ^1,2

1. School of Medicine, University of Electronic Science and Technology of China, Chengdu 610054, P. R. China;
2. Organ Transplantation Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610072, P. R. China;
3. The 5th Assignment Outpatient Department, Western Theater General Hospital, Chengdu 610083, P. R. China;
4. Clinical Medicine College, Chengdu Medical College, Chengdu 610500, P. R. China;

Corresponding author：

ZHANG Yu, Email: 68532815@qq.com

Keywords：

retroperitoneal leiomyosarcoma; orthotopic autologous renal transplantation; inferior vena cava resection and reconstruction; artificial blood vessel; contrast-enhanced ultrasound

DOI：

10.7507/1007-9424.202202017

Video：

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Objective To investigate the application and clinical efficacy of orthotopic autologous renal transplantation combined with inferior vena cava (IVC) resection and reconstruction in retroperitoneal tumor. Methods The clinical data of a patient with complex retroperitoneal tumor was analyzed retrospectively. Abdominal CT examination showed that the tumor originated from IVC and invaded the retrohepatic IVC and bilateral renal vein trunks. Intraoperative ultrasound exploration revealed mechanized thrombosis in the IVC and bilateral renal vein trunks. After blocking the left renal vein, no significant hemodynamic changes were seen before and after intraoperative ultrasound exploration and contrast-enhanced ultrasound. Results After complete removal of the left renal vein and suture of the severed end, the right renal vein was successfully reconstructed with an orthotopic autologous right kidney graft combined with IVC resection after removal of the mechanized thrombus. The patient recovered well after surgery, and a repeat CT showed that the reconstructed artificial IVC was patent, and the color Doppler ultrasonography of both kidneys showed good perfusion and no obstruction of return. The patient was given oral rivaroxaban anticoagulant therapy after operation, and discharged at 19 days after operation. The postoperative pathological findings suggested inferior vena cava smooth muscle sarcoma. Conclusion Orthotopic autologous renal transplantation combined with IVC resection and reconstruction for complex retroperitoneal tumor is safe and feasible, and the left renal vein can be ligated and dissected intraoperatively, but a comprehensive evaluation with intraoperative ultrasound (imaging) is required.

Citation： PANG Beichuan, ZHANG Na, YANG Chong, LIAO Yubo, HUANG Liang, YANG Wenhao, YUAN Chengxiang, ZHANG Yu. Application of orthotopic autologous renal transplantation combined with inferior vena cava resection and reconstruction in retroperitoneal tumor. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2022, 29(8): 1018-1023. doi: 10.7507/1007-9424.202202017 Copy

1.	Rajiah P, Sinha R, Cuevas C, et al. Imaging of uncommon retroperitoneal masses. Radiographics, 2011, 31(4): 949-976.
2.	Osman S, Lehnert BE, Elojeimy S, et al. A comprehensive review of the retroperitoneal anatomy, neoplasms, and pattern of disease spread. Curr Probl Diagn Radiol, 2013, 42(5): 191-208.
3.	Olimpiadi Y, Song S, Hu JS, et al. Contemporary management of retroperitoneal soft tissue sarcomas. Curr Oncol Rep, 2015, 17(8): 39. doi: 10.1007/s11912-015-0462-0.
4.	Sassa N. Retroperitoneal tumors: review of diagnosis and management. Int J Urol, 2020, 27(12): 1058-1070.
5.	Shindo S, Matsumoto H, Ogata K, et al. Surgical treatment of retroperitoneal leiomyosarcoma invading the inferior vena cava: report of three cases. Surg Today, 2002, 32(10): 929-933.
6.	Bretan PN Jr, Williams RD, Hricak H. Preoperative assessment of retroperitoneal pathology by magnetic resonance imaging. Primary leiomyosarcoma of inferior vena cava. Urology, 1986, 28(3): 251-255.
7.	Storm FK, Mahvi DM. Diagnosis and management of retroperitoneal soft-tissue sarcoma. Ann Surg, 1991, 214(1): 2-10.
8.	Hill MA, Mera R, Levine EA. Leiomyosarcoma: a 45-year review at Charity Hospital, New Orleans. Am Surg, 1998, 64(1): 53-60.
9.	Constantinidou A, Jones RL. Systemic therapy in retroperitoneal sarcoma management. J Surg Oncol, 2018, 117(1): 87-92.
10.	Wile AG, Evans HL, Romsdahl MM. Leiomyosarcoma of soft tissue: a clinicopathologic study. Cancer, 1981, 48(4): 1022-1032.
11.	Adam YG, Oland J, Halevy A, et al. Primary retroperitoneal soft-tissue sarcomas. J Surg Oncol, 1984, 25(1): 8-11.
12.	Marko J, Wolfman DJ. Retroperitoneal leiomyosarcoma from the radiologic pathology archives. Radiographics, 2018, 38(5): 1403-1420.
13.	Teixeira FJR Jr, do Couto Netto SD, Perina ALF, et al. Leiomyosarcoma of the inferior vena cava: survival rate following radical resection. 2017, 14(4): 3909-3916.
14.	Kirane A, Crago AM. The importance of surgical margins in retroperitoneal sarcoma. J Surg Oncol, 2016, 113(3): 270-276.
15.	Gaignard E, Bergeat D, Robin F, et al. Inferior vena cava leiomyosarcoma: what method of reconstruction for which type of resection? World J Surg, 2020, 44(10): 3537-3544.
16.	Fonesca N, Silvestre I, Bernardino L, et al. Leiomyosarcoma of the inferior vena cava—a very rare case report. Rev Port Cardiol, 2002, 21(12): 1469-1478.
17.	Kieffer E, Alaoui M, Piette JC, et al. Leiomyosarcoma of the inferior vena cava: experience in 22 cases. Ann Surg, 2006, 244(2): 289-295.
18.	Wang Q, Jiang J, Wang C, et al. Leiomyosarcoma of the inferior vena cava level Ⅱinvolvement: curative resection and reconstruction of renal veins. World J Surg Oncol, 2012, 10: 120. doi: 10.1186/1477-7819-10-120.
19.	Pantoja JL, Patel RP, Baril DT, et al. Caval reconstruction with undersized ringed graft after resection of inferior vena cava leiomyosarcoma. Ann Vasc Surg, 2020, 65: 25-32.
20.	Tantisattamo E, Dafoe DC, Reddy UG, et al. Current management of patients with acquired solitary kidney. Kidney Int Rep, 2019, 4(9): 1205-1218.
21.	Weinstein S, Jordan E, Goldstein R, et al. How to set up a contrast-enhanced ultrasound service. Abdom Radiol (NY), 2018, 43(4): 808-818.
22.	Morgan TA, Jha P, Poder L, et al. Advanced ultrasound applications in the assessment of renal transplants: contrast-enhanced ultrasound, elastography, and B-flow. Abdom Radiol (NY), 2018, 43(10): 2604-2614.
23.	Liu D, Ren HL, Liu B, et al. Renal function preservation in surgical resection of primary inferior vena cava leiomyosarcoma involving the renal veins. Eur J Vasc Endovasc Surg, 2018, 55(2): 229-239.
24.	Sulpice L, Rayar M, Levi Sandri GB, et al. Leiomyosarcoma of the inferior vena cava. J Visc Surg, 2016, 153(3): 161-165.
25.	Bower TC, Nagorney DM, Cherry KJ, et al. Replacement of the inferior vena cava for malignancy: an update. J Vasc Surg, 2000, 31(2): 270-281.
26.	Fiore M, Colombo C, Locati P, et al. Surgical technique, morbidity, and outcome of primary retroperitoneal sarcoma involving inferior vena cava. Ann Surg Oncol, 2012, 19(2): 511-518.
27.	Hicks CW, Glebova NO, Piazza KM, et al. Risk of venous thromboembolic events following inferior vena cava resection and reconstruction. J Vasc Surg, 2016, 63(4): 1004-1010.
28.	Strauss DC, Hayes AJ, Thomas JM. Retroperitoneal tumours: review of management. Ann R Coll Surg Engl, 2011, 93(4): 275-280.
29.	Kumar V, Misra S, Chaturvedi A. Retroperitoneal sarcomas—a challenging problem. Indian J Surg Oncol, 2012, 3(3): 215-221.
30.	von Mehren M, Randall RL, Benjamin RS, et al. Soft tissue sarcoma, Version 2. 2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2018, 16(5): 536-563.

1. Rajiah P, Sinha R, Cuevas C, et al. Imaging of uncommon retroperitoneal masses. Radiographics, 2011, 31(4): 949-976.
2. Osman S, Lehnert BE, Elojeimy S, et al. A comprehensive review of the retroperitoneal anatomy, neoplasms, and pattern of disease spread. Curr Probl Diagn Radiol, 2013, 42(5): 191-208.
3. Olimpiadi Y, Song S, Hu JS, et al. Contemporary management of retroperitoneal soft tissue sarcomas. Curr Oncol Rep, 2015, 17(8): 39. doi: 10.1007/s11912-015-0462-0.
4. Sassa N. Retroperitoneal tumors: review of diagnosis and management. Int J Urol, 2020, 27(12): 1058-1070.
5. Shindo S, Matsumoto H, Ogata K, et al. Surgical treatment of retroperitoneal leiomyosarcoma invading the inferior vena cava: report of three cases. Surg Today, 2002, 32(10): 929-933.
6. Bretan PN Jr, Williams RD, Hricak H. Preoperative assessment of retroperitoneal pathology by magnetic resonance imaging. Primary leiomyosarcoma of inferior vena cava. Urology, 1986, 28(3): 251-255.
7. Storm FK, Mahvi DM. Diagnosis and management of retroperitoneal soft-tissue sarcoma. Ann Surg, 1991, 214(1): 2-10.
8. Hill MA, Mera R, Levine EA. Leiomyosarcoma: a 45-year review at Charity Hospital, New Orleans. Am Surg, 1998, 64(1): 53-60.
9. Constantinidou A, Jones RL. Systemic therapy in retroperitoneal sarcoma management. J Surg Oncol, 2018, 117(1): 87-92.
10. Wile AG, Evans HL, Romsdahl MM. Leiomyosarcoma of soft tissue: a clinicopathologic study. Cancer, 1981, 48(4): 1022-1032.
11. Adam YG, Oland J, Halevy A, et al. Primary retroperitoneal soft-tissue sarcomas. J Surg Oncol, 1984, 25(1): 8-11.
12. Marko J, Wolfman DJ. Retroperitoneal leiomyosarcoma from the radiologic pathology archives. Radiographics, 2018, 38(5): 1403-1420.
13. Teixeira FJR Jr, do Couto Netto SD, Perina ALF, et al. Leiomyosarcoma of the inferior vena cava: survival rate following radical resection. 2017, 14(4): 3909-3916.
14. Kirane A, Crago AM. The importance of surgical margins in retroperitoneal sarcoma. J Surg Oncol, 2016, 113(3): 270-276.
15. Gaignard E, Bergeat D, Robin F, et al. Inferior vena cava leiomyosarcoma: what method of reconstruction for which type of resection? World J Surg, 2020, 44(10): 3537-3544.
16. Fonesca N, Silvestre I, Bernardino L, et al. Leiomyosarcoma of the inferior vena cava—a very rare case report. Rev Port Cardiol, 2002, 21(12): 1469-1478.
17. Kieffer E, Alaoui M, Piette JC, et al. Leiomyosarcoma of the inferior vena cava: experience in 22 cases. Ann Surg, 2006, 244(2): 289-295.
18. Wang Q, Jiang J, Wang C, et al. Leiomyosarcoma of the inferior vena cava level Ⅱinvolvement: curative resection and reconstruction of renal veins. World J Surg Oncol, 2012, 10: 120. doi: 10.1186/1477-7819-10-120.
19. Pantoja JL, Patel RP, Baril DT, et al. Caval reconstruction with undersized ringed graft after resection of inferior vena cava leiomyosarcoma. Ann Vasc Surg, 2020, 65: 25-32.
20. Tantisattamo E, Dafoe DC, Reddy UG, et al. Current management of patients with acquired solitary kidney. Kidney Int Rep, 2019, 4(9): 1205-1218.
21. Weinstein S, Jordan E, Goldstein R, et al. How to set up a contrast-enhanced ultrasound service. Abdom Radiol (NY), 2018, 43(4): 808-818.
22. Morgan TA, Jha P, Poder L, et al. Advanced ultrasound applications in the assessment of renal transplants: contrast-enhanced ultrasound, elastography, and B-flow. Abdom Radiol (NY), 2018, 43(10): 2604-2614.
23. Liu D, Ren HL, Liu B, et al. Renal function preservation in surgical resection of primary inferior vena cava leiomyosarcoma involving the renal veins. Eur J Vasc Endovasc Surg, 2018, 55(2): 229-239.
24. Sulpice L, Rayar M, Levi Sandri GB, et al. Leiomyosarcoma of the inferior vena cava. J Visc Surg, 2016, 153(3): 161-165.
25. Bower TC, Nagorney DM, Cherry KJ, et al. Replacement of the inferior vena cava for malignancy: an update. J Vasc Surg, 2000, 31(2): 270-281.
26. Fiore M, Colombo C, Locati P, et al. Surgical technique, morbidity, and outcome of primary retroperitoneal sarcoma involving inferior vena cava. Ann Surg Oncol, 2012, 19(2): 511-518.
27. Hicks CW, Glebova NO, Piazza KM, et al. Risk of venous thromboembolic events following inferior vena cava resection and reconstruction. J Vasc Surg, 2016, 63(4): 1004-1010.
28. Strauss DC, Hayes AJ, Thomas JM. Retroperitoneal tumours: review of management. Ann R Coll Surg Engl, 2011, 93(4): 275-280.
29. Kumar V, Misra S, Chaturvedi A. Retroperitoneal sarcomas—a challenging problem. Indian J Surg Oncol, 2012, 3(3): 215-221.
30. von Mehren M, Randall RL, Benjamin RS, et al. Soft tissue sarcoma, Version 2. 2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw, 2018, 16(5): 536-563.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of orthotopic autologous renal transplantation combined with inferior vena cava resection and reconstruction in retroperitoneal tumor

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