Abstract
Purpose
To investigate the frequency of aberrations of retroperitoneal great vessels in patients with gynecologic cancers who were scheduled for pelvic and paraaortic lymphadenectomy, and to document the vascular complications which occurred during lymphadenectomy as well as the relationship of these vascular complications with vascular aberrations.
Methods
Patients with gynecologic cancers underwent a routine preoperative abdominal multi-detector computer tomography, and an intraoperative search for aberrations of the great vessels in the retroperitoneal region was undertaken. Intraoperative vascular complications were recorded and their relations to vascular aberrations were analyzed.
Results
The rate of vascular aberrations detected preoperatively by multi-detector computed tomography was 24.3 %. Vascular injuries occurred in six patients (16.2 %) during lymphadenectomy. Rate of intraoperative vascular injuries was significantly higher in patients who had vascular aberrations of retroperitoneal great vessels (44.4 vs. 7.1 %, p = 0.022).
Conclusions
Aberrations of retroperitoneal vessels are not uncommon and may increase the risk of vascular complications during lymphadenectomy. The risk of these complications may be decreased if aberrations are detected preoperatively.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Zivanovic O, Sheinfeld J, Abu-Rustum NR (2008) Retroperitoneal lymph node dissection (RPLND). Gynecol Oncol 111(2 Suppl):S66–S69
Ben-Shachar I, Pavelka J, Cohn DE, Copeland LJ, Ramirez N, Manolitsas T, Fowler JM (2005) Surgical staging for patients presenting with grade 1 endometrial carcinoma. Obstet Gynecol 105:487–493
Goff BA, Muntz HG, Paley PJ, Tamimi HK, Koh WJ, Greer BE (1999) Impact of surgical staging in women with locally advanced cervical cancer. Gynecol Oncol 74:436–442
Larson DM, Johnson K, Olson KA (1992) Pelvic and paraaortic lymphadenectomy for surgical staging of endometrial cancer: morbidity and mortality. Obstet Gynecol 79:998–1001
Homesley HD, Kadar N, Barrett RJ, Lentz SS (1992) Selective pelvic and periaortic lymphadenectomy does not increase morbidity in surgical staging of endometrial carcinoma. Am J Obstet Gynecol 167:1225–1230
Everett E, Tamimi H, Greer B, Swisher E, Paley P, Mandel L, Goff B (2003) The effect of body mass index on clinical/pathologic features, surgical morbidity, and outcome in patients with endometrial cancer. Gynecol Oncol 90:150–157
Kilgore LC, Partridge EE, Alvarez RD, Austin JM, Shingleton HM, Noojin F 3rd, Conner W (1995) Adenocarcinoma of the endometrium: survival comparisons of patients with and without pelvic node sampling. Gynecol Oncol 56:29–33
Ayhan A, Tuncer ZS, Yarali H (1991) Complications of radical hysterectomy in women with early stage cervical cancer: clinical analysis of 270 cases. Eur J Surg Oncol 17:492–494
Bartle EJ, Pearce WH, Sun JH, Rutherford RB (1987) Infrarenal venous anomalies and aortic surgery: avoiding vascular injury. J Vasc Surg 6:590–593
Aljabri B, MacDonald PS, Satin R, Stein LS, Obrand DI, Steinmetz OK (2001) Incidence of major venous and renal anomalies relevant to aortoiliac surgery as demonstrated by computed tomography. Ann Vasc Surg 15:615–618
Benedetti-Panici P, Maneschi F, Scambia G, Greggi S, Mancuso S (1994) Anatomic abnormalities of the retroperitoneum encountered during aortic and pelvic lymphadenectomy. Am J Obstet Gynecol 170(1 Pt 1):111–116
Koc Z, Ulusan S, Oguzkurt L, Tokmak N (2007) Venous variants and anomalies on routine abdominal multi-detector row CT. Eur J Radiol 61:267–278
Downey RS, Sicard GA, Anderson CB (1989) Major retroperitoneal venous anomalies: surgical considerations. Surgery 107:359–365
Fishman EK (2001) CT angiography: clinical applications in the abdomen. Radiographics 21:453–516
Guven K, Acunas B (2004) Multidetector computed tomography angiography of the abdomen. Eur J Radiol 52:44–55
Reed MD, Friedman AC, Nealey P (1982) Anomalies of the left renal vein: analysis of 433 CT scans. J Comput Assist Tomogr 6:1124–1126
Trigaux JP, Vandroogenbroek S, De Wispelaere JF, Lacrosse M, Jamart J (1998) Congenital anomalies of the inferior vena cava and left renal vein: evaluation with spiral CT. J Vasc Interv Radiol 9:339–345
Giordano JM, Trout HH (1986) Anomalies of the inferior vena cava. J Vasc Surg 3:924–928
Vidal V, Monnet O, Jacquier A, Bartoli JM, Tropiano P (2010) Accessory iliac vein: surgical implications. J Spinal Disord Tech 23:398–403
Morrow CP, Curtin JP (1996) Gynecologic cancer surgery., Surgical anatomyChurchill Livingstone, New York, pp 97–109
Eitan R, Abu-Rustum NR, Walker JL, Barakat RR (2003) Ligation of an anatomic variant of renal vasculature during laparoscopic periaortic lymph node dissection: a cause of postoperative renal infarction. Gynecol Oncol 91:416–420
Conflict of interest
We declare that we have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gyimadu, A., Salman, M.C., Karcaaltincaba, M. et al. Retroperitoneal vascular aberrations increase the risk of vascular injury during lymphadenectomy in gynecologic cancers. Arch Gynecol Obstet 286, 449–455 (2012). https://doi.org/10.1007/s00404-012-2285-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-012-2285-7