Temporary Vascular Debranching to Facilitate Retroperitoneal Tumour en bloc Resection

BACKGROUND: Oncovascular teams are known to be a cornerstone in planning and facilitating en bloc resection of large retroperitoneal masses. Vascular surgeons can help with dissection close to major vessels by vascular reconstruction when necessary, and also in performing specific procedures that can facilitate safe and optimal tumour mass resection. Two cases are reported where temporary vascular debranching of major arteries allowed safe tumour harvesting. CASE REPORTS: A 68 year old man with a necrotic retroperitoneal carcinoma underwent en bloc resection with temporary debranching of the coeliac trunk, superior mesenteric artery, and right renal artery using a multibranched bypass from the axillary artery. The post-operative course included septic shock related to pulmonary infection requiring a 10 day stay in the intensive care unit (ICU). Renal function was normalised on day two. The patient was discharged on day 18. However, he died 78 months post-operatively from pulmonary metastases after anti-angiogenic treatment. A 34 year old man with a retroperitoneal mature teratoma underwent en bloc resection with temporary debranching of the coeliac trunk, superior mesenteric artery, left and right renal arteries, and left and right common iliac arteries, with a multibranched bypass from the axillary artery. Post-operatively he required a five day stay in the ICU. Acute kidney injury (AKI) was noted, but it resolved without dialysis. The patient was discharged on day 16. After 78 months follow up he presented with chronic renal failure requiring dialysis. Follow up computed tomography angiography showed pulmonary metastases; although the metastases were manageable with surgical treatment, the patient refused further care. CONCLUSIONS: Temporary extra-anatomical bypass from the axillary artery to the visceral arteries could be considered as an option to provide adequate perfusion and to prevent visceral ischaemia during en bloc resection of large retroperitoneal masses.