Inferior vena cava resection and reconstruction during PC-RPLND for NSGCT in a patient with horseshoe kidney (SIU 2011)
- uploaded: Jul 22, 2011
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Institution:Ospedale â€œSan Giovanni Battista â€“ Molinetteâ€, Torino, Italy
Introduction & objectives
Involvement of the infrahepatic inferior vena cava (IVC) by urological malignancies is uncommon. Between 6% and 12% of patients undergoing post-chemotherapy retroperitoneal lymph node dissection (PCRPLND) will have involvement of the IVC requiring resection. IVC reconstruction has been described in urologic and nonurologic malignancies, but seldom in germ cell tumors.
Material & Methods
We are going to present the case of a twenty-one-year-old patient, affected by metastatic non seminomatous germ cell tumour. According to the prognostic-based staging system for metastatic germ cell cancer, our patient was in the poor prognosis group. He underwent a four cycles EP chemotherapy and then a salvage chemotherapy with four cycles of VIP. After chemotherapy, the CT scan showed a reduction in size of all the metastases, but the CT-PET showed an active disease in the retroperitoneal lymph nodes. The patient was then proposed for the resection of residual tumour. The retroperitoneal mass resulted adherent to the inferior vena cava and to the psoas muscle. The mass seemed to infiltrate completely the vena cava, and it was not possibile to dissect the mass without open the wall of the vein. After obtaining a successful haemostasis, of a segment of the vena cava, infiltrated by the lesion, was resected. The inferior vena cava was isolated above and below the retroperitoneal mass and finally removed. The inferior vena cava was reconstructed through a Gore-Tex tube graft.
The CT scan performed one month after the procedure did not show any retro-peritoneal relapse. Afterwards, the patients experienced a brain recurrence, surgically resected, and he is undergoing a third line chemotherapy with TIP. The patient is still under anticoagulant therapy and the graft is patent.
Our experience confirms that resection and reconstruction of IVC is safe and feasible also in presence of anatomic abnormalities, such as horseshoe kidney.
IVC resection should be considered in all the cases with a complete IVC involvement, in order to obtain a radical post-chemotherapy retro-peritoneal lymphadenectomy.
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