RETROPERİTONEAL VASKÜLER VARYASYONLAR VE JİNEKOLOJİK ONKOLOJİ CERRAHİSİNDEKİ ÖNEMİ

Abstract

Amaç: Sistematik retroperitoneal lenf nodu diseksiyonu, jinekolojik onkoloji cerrahisindeki en önemli prosedürlerden birisi olmasının yanında performans skoru yüksek olan genç hastalarda bile ciddi morbidite ve komplikasyonlara neden olabilmektedir. Retroperitoneal vasküler varyasyonlar nadir olmamakla birlikte hemen tamamı intraoperatif büyük damar yaralanmasını takiben tanınabilmektedir. Bu yazıda retroperitoneal vasküler varyasyonlarla ilgili tecrübelerimizi ve bunların jinekolojik onkoloji cerrahisindeki önemini vurgulamaya çalışacağız. Metod: Ocak 2011 ve Ocak 2014 tarihleri arasında merkezimiz Jinekolojik Onkoloji Kliniği’nde retroperitoneal lenf nodu diseksiyonu yapılan hastaların ameliyat notları ve klinik fotoğraf arşivi retrospektif olarak incelenmiştir. Bulgular: Belirtilen zaman aralığında 621 hastaya merkezimizde pelvik ve para aortik lenf nodu diseksiyonu yapıldı. Toplam 28 hastada (4.5%) majör retroperitoneal vasküler varyasyon izlenmiştir. Bu hastaların üçünde majör vasküler komplikasyon yaşanmıştır, bunlardan birinde renal polar arter hasarı nedeniyle alt renal polde iskemik nekroz meydana gelmiştir. Bunun yanında normal anatomi izlenen hastaların 22 tanesinde (3.6%) çeşitli derecelerde vasküler yaralanma tespit edilmiştir. Sonuç: Retroperitoneal varyasyonlar nadir değildir ve en sık venöz sisteme ait varyasyonlar görülmektedir. Varyasyonların preoperatif tanı konması cerrahlara intraoperatif kolaylık sağlayabilir ancak çoğu vakada bu mümkün olmamaktadır. Bu nedenle sistematik retroperitoneal lenf nodu diseksiyonu sırasında retroperitoneal alandaki muhtemel aberasyon ve varyasyonlar açısından dikkatli olunması gerekmektedir

Keywords

• Vasküler varyasyon, retroperitoneal, jinekolojik onkoloji cerrahisi, cerrahi morbidite

RETROPERİTONEAL VASCULAR VARİATİONS AND THEİR SİGNİFİCANCE ON GYNECOLOGİC ONCOLOGY SURGERY

Abstract

Aim: Although systematic retroperitoneal lymphadenectomy is an essential part of most of the gynaecological oncology surgeries, this procedure may be responsible for significant morbidities and complications even for young patients with good performance status. Retroperitoneal vascular variations are not uncommon and are almost always diagnosed with intraoperative vessel injury. We are presenting our experience about retroperitoneal vascular variations and their major implications on gynaecological oncology surgeries. Methods: We collected the surgical data and operative notes of the patients who underwent retroperitoneal lymph node dissection for various indications in Gynecologic Oncology Department of our tertiary care hospital between January 2011 and January 2014. Results: A total of 621 patients underwent pelvic and paraaortic lymphadenectomy during the aforementioned time period. Totally 28 (4.5%) retroperitoneal vascular variations were detected. We had three complications (10.7%) one of them was the injury of a polar artery and resulted with renal ischemia in the lower pole of the right kidney. On the other hand, our major vascular injury rate in women with a normal anatomy was 3.6% (n=22). Conclusion: Retroperitoneal variations are not uncommon and variations of the venous system are the most common. Preoperative detection of them may guide the surgeon during the operation. Otherwise, the surgeon should always be cautious about vascular variations during systematic retroperitoneal lymphadenectomy

Keywords

• Vascular variations, retroperitoneal, gynecologic oncology surgery, surgical morbidity

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