Yıl 2014, Cilt 17 , Sayı 4, Sayfalar 0 - 0 2014-10-01

RETROPERİTONEAL VASCULAR VARİATİONS AND THEİR SİGNİFİCANCE ON GYNECOLOGİC ONCOLOGY SURGERY
RETROPERİTONEAL VASKÜLER VARYASYONLAR VE JİNEKOLOJİK ONKOLOJİ CERRAHİSİNDEKİ ÖNEMİ

Murat Öz [1] , Salim Erkaya [2] , Bülent Özdal [3] , Mehmet Mutjlu Meydanlı [4] , İlker Selçuk [5] , Tayfun Güngör [6]


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
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
  • 1. May K, Bryant A, Dickinson HO, Kehoe S, Morrison J. Lymphadenectomy for the management of endometrial cancer. The Cochrane database of systematic reviews. 2010(1):CD007585.
  • 2. Arduino S, Leo L, Febo G, Tessarolo M, Wierdis T, Lanza A. Complications of pelvic and para-aortic lymphadenectomy in patients with endometrial cancer. European journal of gynaecological oncology. 1997;18(3):208-10.
  • 3. Aljabri B, MacDonald PS, Satin R, Stein LS, Obrand DI, Steinmetz OK. Incidence of major venous and renal anomalies relevant to aortoiliac surgery as demonstrated by computed tomography. Annals of vascular surgery. 2001;15(6):615-8.
  • 4. Venieratos D, Panagouli E, Lolis E. Variations of the iliac and pelvic venous systems with special attention to the drainage patterns of the ascending lumbar and iliolumbar veins. Annals of anatomy = Anatomischer Anzeiger : official organ of the Anatomische Gesellschaft. 2012;194(4):396-403.
  • 5. Chakravarthi KK. Unilateral multiple variations of renal, phrenic, suprarenal, inferior mesenteric and gonadal arteries. Journal of natural science, biology, and medicine. 2014;5(1):173-5.
  • 6. Yi SQ, Ueno Y, Naito M, Ozaki N, Itoh M. The three most common variations of the left renal vein: a review and meta-analysis. Surgical and radiologic anatomy : SRA. 2012;34(9):799-804.
  • 7. Hashmi ZA, Smaroff GG. Dual inferior vena cava: two inferior vena cava filters. The Annals of thoracic surgery. 2007;84(2):661-3.
  • 8. Cho BC, Choi HJ, Kang SM, Chang J, Lee SM, Yang DG, et al. Congenital absence of inferior vena cava as a rare cause of pulmonary thromboembolism. Yonsei medical journal. 2004;45(5):947-51.
  • 9. Spentzouris G, Zandian A, Cesmebasi A, Kinsella CR, Muhleman M, Mirzayan N, et al. The clinical anatomy of the inferior vena cava: a review of common congenital anomalies and considerations for clinicians. Clinical anatomy. 2014;27(8):1234-43.
  • 10. Kapetanakis S, Papadopoulos C, Galani P, Dimitrakopoulou G, Fiska A. Anomalies of the inferior vena cava: a report of two cases and a short review of the literature. Folia morphologica. 2010;69(3):123-7.
  • 11. Chen H, Emura S, Nagasaki S, Kubo KY. Double inferior vena cava with interiliac vein: a case report and literature review. Okajimas folia anatomica Japonica. 2012;88(4):147- 51.
  • 12. Itoh M, Moriyama H, Tokunaga Y, Miyamoto K, Nagata W, Satriotomo I, et al. Embryological consideration of drainage of the left testicular vein into the ipsilateral renal vein: analysis of cases of a double inferior vena cava. International journal of andrology. 2001;24(3):142-52.
  • 13. Tore HG, Tatar I, Celik HH, Oto A, Aldur MM, Denk CC. Two cases of inferior vena cava duplication with their CT findings and a review of the literature. Folia morphologica. 2005;64(1):55-8.
  • 14. Babaian RJ, Johnson DE. Major venous anomalies complicating retroperitoneal surgery. Southern medical journal. 1979;72(10):1254-8.
  • 15. Sartori MT, Zampieri P, Andres AL, Prandoni P, Motta R, Miotto D. Double vena cava filter insertion in congenital duplicated inferior vena cava: a case report and literature review. Haematologica. 2006;91(6 Suppl):ECR30.
  • 16. Vs G, Nn H, Pd D, Nb M, Ss B. Retrocaval ureter: an innocent bystander. Journal of clinical and diagnostic research : JCDR. 2014;8(5):ND05-6.
  • 17. Nanda S, Bhatt SP, Turki MA. Inferior vena cava anomalies-a common cause of DVT and PE commonly not diagnosed. The American journal of the medical sciences. 2008;335(5):409-10.
  • 18. Gyimadu A, Salman MC, Karcaaltincaba M, Yuce K. Retroperitoneal vascular aberrations increase the risk of vascular injury during lymphadenectomy in gynecologic cancers. Archives of gynecology and obstetrics. 2012;286(2):449- 55.
  • 19. Nam JK, Park SW, Lee SD, Chung MK. The clinical significance of a retroaortic left renal vein. Korean journal of urology. 2010;51(4):276-80.
  • 20. Kaneko N, Kobayashi Y, Okada Y. Anatomic variations of the renal vessels pertinent to transperitoneal vascular control in the management of trauma. Surgery. 2008;143(5):616-22.
  • 21. Koc Z, Ulusan S, Oguzkurt L. Association of left renal vein variations and pelvic varices in abdominal MDCT. European radiology. 2007;17(5):1267-74.
  • 22. Kose MF, Turan T, Karasu Y, Gundogdu B, Boran N, Tulunay G. Anomalies of major retroperitoneal vascular structure. International journal of gynecological cancer : official journal of the International Gynecological Cancer Society. 2011;21(7):1312-9.
  • 23. Reis RH, Esenther G. Variations in the pattern of renal vessels and their relation to the type of posterior vena cava in man. The American journal of anatomy. 1959;104:295-318.
  • 24. Gramegna V, Madaro A, Pellegrini F, Capizzi S, Romano O, Massari D, et al. A rare case of retrocaval ureter associated with persistent left vena cava. Urologia internationalis. 2003;70(4):337-8.
  • 25. Bordei P, Sapte E, Iliescu D. Double renal arteries originating from the aorta. Surgical and radiologic anatomy : SRA. 2004;26(6):474-9.
  • 26. Satyapal KS, Haffejee AA, Singh B, Ramsaroop L, Robbs JV, Kalideen JM. Additional renal arteries: incidence and morphometry. Surgical and radiologic anatomy : SRA. 2001;23(1):33-8.
  • 27. Xue HG, Yang CY, Asakawa M, Tanuma K, Ozawa H. Duplication of the inferior vena cava associated with other variations. Anatomical science international. 2007;82(2):121-5.
  • 28. Hayashi S, Naito M, Hirai S, Terayama H, Miyaki T, Itoh M, et al. Proposal for a new classification of variations in the iliac venous system based on internal iliac veins: a case series and a review of double and left inferior vena cava. Anatomical science international. 2013;88(4):183-8.
  • 29. Klemm P, Frober R, Kohler C, Schneider A. Vascular anomalies in the paraaortic region diagnosed by laparoscopy in patients with gynaecologic malignancies. Gynecologic oncology. 2005;96(2):278-82.
  • 30. Koc Z, Ulusan S, Oguzkurt L, Tokmak N. Venous variants and anomalies on routine abdominal multi-detector row CT. European journal of radiology. 2007;61(2):267-78.
Diğer ID JA39EC43AF
Bölüm Araştırma Makalesi
Yazarlar

Yazar: Murat Öz

Yazar: Salim Erkaya

Yazar: Bülent Özdal

Yazar: Mehmet Mutjlu Meydanlı

Yazar: İlker Selçuk

Yazar: Tayfun Güngör

Tarihler

Yayımlanma Tarihi : 1 Ekim 2014

Bibtex @ { trsgo471757, journal = {Türk Jinekolojik Onkoloji Dergisi}, issn = {2148-5372}, address = {trsgo.dergisi@yahoo.com}, publisher = {Türk Jinekolojik Onkoloji Derneği}, year = {2014}, volume = {17}, pages = {0 - 0}, doi = {}, title = {RETROPERİTONEAL VASKÜLER VARYASYONLAR VE JİNEKOLOJİK ONKOLOJİ CERRAHİSİNDEKİ ÖNEMİ}, key = {cite}, author = {Öz, Murat and Erkaya, Salim and Özdal, Bülent and Meydanlı, Mehmet Mutjlu and Selçuk, İlker and Güngör, Tayfun} }
APA Öz, M , Erkaya, S , Özdal, B , Meydanlı, M , Selçuk, İ , Güngör, T . (2014). RETROPERİTONEAL VASKÜLER VARYASYONLAR VE JİNEKOLOJİK ONKOLOJİ CERRAHİSİNDEKİ ÖNEMİ. Türk Jinekolojik Onkoloji Dergisi , 17 (4) , 0-0 . Retrieved from https://dergipark.org.tr/tr/pub/trsgo/issue/39802/471757
MLA Öz, M , Erkaya, S , Özdal, B , Meydanlı, M , Selçuk, İ , Güngör, T . "RETROPERİTONEAL VASKÜLER VARYASYONLAR VE JİNEKOLOJİK ONKOLOJİ CERRAHİSİNDEKİ ÖNEMİ". Türk Jinekolojik Onkoloji Dergisi 17 (2014 ): 0-0 <https://dergipark.org.tr/tr/pub/trsgo/issue/39802/471757>
Chicago Öz, M , Erkaya, S , Özdal, B , Meydanlı, M , Selçuk, İ , Güngör, T . "RETROPERİTONEAL VASKÜLER VARYASYONLAR VE JİNEKOLOJİK ONKOLOJİ CERRAHİSİNDEKİ ÖNEMİ". Türk Jinekolojik Onkoloji Dergisi 17 (2014 ): 0-0
RIS TY - JOUR T1 - RETROPERİTONEAL VASKÜLER VARYASYONLAR VE JİNEKOLOJİK ONKOLOJİ CERRAHİSİNDEKİ ÖNEMİ AU - Murat Öz , Salim Erkaya , Bülent Özdal , Mehmet Mutjlu Meydanlı , İlker Selçuk , Tayfun Güngör Y1 - 2014 PY - 2014 N1 - DO - T2 - Türk Jinekolojik Onkoloji Dergisi JF - Journal JO - JOR SP - 0 EP - 0 VL - 17 IS - 4 SN - 2148-5372- M3 - UR - Y2 - 2019 ER -
EndNote %0 Türk Jinekolojik Onkoloji Dergisi RETROPERİTONEAL VASKÜLER VARYASYONLAR VE JİNEKOLOJİK ONKOLOJİ CERRAHİSİNDEKİ ÖNEMİ %A Murat Öz , Salim Erkaya , Bülent Özdal , Mehmet Mutjlu Meydanlı , İlker Selçuk , Tayfun Güngör %T RETROPERİTONEAL VASKÜLER VARYASYONLAR VE JİNEKOLOJİK ONKOLOJİ CERRAHİSİNDEKİ ÖNEMİ %D 2014 %J Türk Jinekolojik Onkoloji Dergisi %P 2148-5372- %V 17 %N 4 %R %U
ISNAD Öz, Murat , Erkaya, Salim , Özdal, Bülent , Meydanlı, Mehmet Mutjlu , Selçuk, İlker , Güngör, Tayfun . "RETROPERİTONEAL VASKÜLER VARYASYONLAR VE JİNEKOLOJİK ONKOLOJİ CERRAHİSİNDEKİ ÖNEMİ". Türk Jinekolojik Onkoloji Dergisi 17 / 4 (Ekim 2014): 0-0 .
AMA Öz M , Erkaya S , Özdal B , Meydanlı M , Selçuk İ , Güngör T . RETROPERİTONEAL VASKÜLER VARYASYONLAR VE JİNEKOLOJİK ONKOLOJİ CERRAHİSİNDEKİ ÖNEMİ. TRSGO Dergisi. 2014; 17(4): 0-0.
Vancouver Öz M , Erkaya S , Özdal B , Meydanlı M , Selçuk İ , Güngör T . RETROPERİTONEAL VASKÜLER VARYASYONLAR VE JİNEKOLOJİK ONKOLOJİ CERRAHİSİNDEKİ ÖNEMİ. Türk Jinekolojik Onkoloji Dergisi. 2014; 17(4): 0-0.