01 May 2021: Articles
Aggressive Resection of Malignant Paraaortic and Pelvic Tumors Accompanied by Arterial Reconstruction with Synthetic Arterial Graft
Unusual setting of medical care
Ryotaro Tani * , Tomohide Hori ** , Hidekazu Yamamoto D , Hideki Harada D , Michihiro Yamamoto D , Masahiro Yamada D , Takefumi Yazawa D , Ben Sasaki D , Masaki Tani D , Asahi Sato D , Hikotaro Katsura D , Yasuyuki Kamada D , Ryuhei Aoyama D , Yudai Sasaki D , Masazumi Zaima ADOI: 10.12659/AJCR.931569
Am J Case Rep 2021; 22:e931569
Table 2. Intraoperative findings and pathological assessments of PPTs.
| Case | Operative time [minute] | Blood loss [ml] | Blood transfusion [unit or ml] | Arterial reconstruction with SAG | Resection of the IVC | Curability* | ||
|---|---|---|---|---|---|---|---|---|
| The range of prosthetic replacement | Orthotopically replaced artery | Graft type | ||||||
| 1 | 376 | 1546 | RBC, 4 units | The lower level of the RA to the upper level of the IMA | Abdominal aorta | I-shaped | Yes (IVC and LRV) | Yes |
| 2 | 520 | 1851 | RBC, 4 units | The root of the IMA to the CIAs 1 cm distal to the bifurcation bilaterally | Abdominal aorta | Y-shaped | Yes (partial resection) | Yes |
| Autotransfusion, 400 ml | CIAs | |||||||
| 3 | 250 | 885 | RBC, 2 units | The lower level of the RA to the CIAs distal to the bifurcation bilaterally | Abdominal aorta | Y-shaped | No | Yes |
| CIAs | ||||||||
| 4 | 679 | 3280 | RBC, 4 units Fresh frozen plasma, 4 units | The lower level of the RA to the CIAs distal to the bifurcation bilaterally | Abdominal aorta | Y-shaped | No | Yes |
| CIAs | ||||||||
| 5 | 193 | 430 | None | The lower level of the RA to the lower level of the IMA | Abdominal aorta | I-shaped | No | Yes |
| 6 | 246 | 3489 | RBC, 10 units | The lower level of the RA to the CIAs distal to the bifurcation bilaterally | CIAs | Y-shaped | No | Yes |
| Fresh frozen plasma, 18 units | Abdominal aorta | |||||||
| 7 | 234 | 1076 | RBC, 2 units | The lower level of the RA to the CIAs distal to the bifurcation bilaterally | CIAs | Y-shaped | No | Yes |
| Abdominal aorta | ||||||||
| * Graphical and surgical findings; ** Clavien-Dindo classification; *** the numbers of LNs in the PPT. CIA – common iliac artery; IMA – inferior mesenteric artery; IVC – inferior vena cava; LRV – left renal vein; LN – lymph node; PPT – paraaortic and/or pelvic tumor; RA – renal artery; RBC – red blood cell; SAG – synthetic arterial graft. | ||||||||
| Case | Postoperative course** [grade] | Pathological assessments | ||||||
| PPT | Paraaortic and/or pelvic LNs*** | Tumor exposure on the cut surface | Tumor invasion into the arterial wall | |||||
| Harvested LNs | Metastatic LNs | |||||||
| 1 | 0 | Carcinosarcoma (malignant mixed Müllerian tumor [homologous type]) | 2 | 2 | No | No | ||
| 2 | 0 | Endometrial carcinoma (endometrioid adenocarcinoma) | 22 | 17 | No | No | ||
| 3 | 0 | Malignant melanoma | 1 | 1 | No | Yes | ||
| 4 | 0 | Endometrial carcinoma with squamous differentiation | 21 | 2 | No | No | ||
| 5 | 0 | Moderately-differentiated tubular adenocarcinoma | 7 | 7 | No | Yes | ||
| 6 | 1 | Moderately-differentiated tubular adenocarcinoma | 2 | 0 | No | Yes | ||
| 7 | 0 | Moderately-differentiated tubular adenocarcinoma | 2 | 2 | No | Yes | ||
| * Graphical and surgical findings; ** Clavien-Dindo classification; *** the numbers of LNs in the PPT. CIA – common iliac artery; IMA – inferior mesenteric artery; IVC – inferior vena cava; LRV – left renal vein; LN – lymph node; PPT – paraaortic and/or pelvic tumor; RA – renal artery; RBC – red blood cell; SAG – synthetic arterial graft. | ||||||||