Aggressive Resection of Malignant Paraaortic and Pelvic Tumors Accompanied by Arterial Reconstruction with Synthetic Arterial Graft

Ryotaro Tani; Tomohide Hori; Hidekazu Yamamoto; Hideki Harada; Michihiro Yamamoto; Masahiro Yamada; Takefumi Yazawa; Ben Sasaki; Masaki Tani; Asahi Sato; Hikotaro Katsura; Yasuyuki Kamada; Ryuhei Aoyama; Yudai Sasaki; Masazumi Zaima

doi:10.12659/AJCR.931569

01 May 2021 : Case report Japan

Aggressive Resection of Malignant Paraaortic and Pelvic Tumors Accompanied by Arterial Reconstruction with Synthetic Arterial Graft

Unusual setting of medical care

Ryotaro Tani^1BDF, Tomohide Hori^1ABCDEF*, Hidekazu Yamamoto^1DF, Hideki Harada^1DF, Michihiro Yamamoto^1DF, Masahiro Yamada^1DF, Takefumi Yazawa^1DF, Ben Sasaki^1DF, Masaki Tani^1DF, Asahi Sato^1DF, Hikotaro Katsura^1DF, Yasuyuki Kamada^1DF, Ryuhei Aoyama^1DF, Yudai Sasaki^1DF, Masazumi Zaima^1ADF

DOI: 10.12659/AJCR.931569

Am J Case Rep 2021; 22:e931569

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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*
Case	Operative time [minute]	Blood loss [ml]	Blood transfusion [unit or ml]	The range of prosthetic replacement	Orthotopically replaced artery	Graft type	Resection of the IVC	Curability*
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
2	520	1851	Autotransfusion, 400 ml		CIAs	Y-shaped	Yes (partial resection)	Yes
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
3	250	885	RBC, 2 units		CIAs	Y-shaped	No	Yes
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
4	679	3280	RBC, 4 units Fresh frozen plasma, 4 units		CIAs	Y-shaped	No	Yes
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
6	246	3489	Fresh frozen plasma, 18 units		Abdominal aorta	Y-shaped	No	Yes
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
7	234	1076	RBC, 2 units		Abdominal aorta	Y-shaped	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.
Case	Postoperative course** [grade]	Pathological assessments
		PPT	Paraaortic and/or pelvic LNs***		Tumor exposure on the cut surface	Tumor invasion into the arterial wall
		PPT	Harvested LNs	Metastatic LNs	Tumor exposure on the cut surface	Tumor invasion into the arterial wall
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.

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Aggressive Resection of Malignant Paraaortic and Pelvic Tumors Accompanied by Arterial Reconstruction with Synthetic Arterial Graft

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