Surgical treatment of abdominal tumors closely related to major blood vessels

Abstract

INTRODUCTION Radical operative treatment of abdominal tumors closely related to major blood vessels often demands complex vascular procedures. OBJECTIVE The aim of this paper was to present elementary principles and results of the complex procedures, based on 46 patients operated on at the Institute for Cardiovascular Diseases, Clinical Centre of Serbia, Belgrade, from January 1999 to July 2006. METHOD Primary localization of the tumor was the kidney in 14 patients, the suprarenal gland in 2, the retroperitoneum in 23 and the testis in 7 patients. Histologically, the most frequent were the following: renal carcinoma in 14 patients, teratoma in 7, liposarcoma in 5, fibrosarcoma and lymphoma in 3 patients. The tumor compressed abdominal aorta occurred in 3 cases, vena cava inferior in 5 and both the abdominal aorta and vena cava inferior in 11 cases. In 4 cases the tumor infiltrated the abdominal aorta, in 11 the vena cava inferior and in 8 both of them. In two patients, the tumor compressed the vena cava inferior and infiltrated the aorta; in two patients the aorta was compressed and the vena cava was infiltrated. In three cases only the exploration was performed due to multiple abdominal organ infiltration. The ex tempore biopsy showed the type of tumor in which the radical surgical treatment did not improve the prognosis. In 20 cases of tumor compression, subadventitional excision was performed. In 23 cases of infiltration, the tumor excision and vascular reconstruction had to be performed. Intraoperative blood cell saving and autotransfusion were applied in 27 patients. RESULTS The lethal outcome happened in 3 (6.5%) patients during hospitalization. In other patients all reconstructed blood vessels were patent during the postoperative hospitalization period. CONCLUSION Treatment of the abdominal tumors closely related to major blood vessels must be interdisciplinary, considering diagnostics, operability estimation and additional measures. Tumor reduction cannot improve long term prognosis, and has no major impact on life quality. There have been not many papers that analyze the long term results after such complex operations proving their appropriateness.

Keywords

• retroperitoneal neoplasms
• vascular surgical procedures
• autologous blood transfusion