Soejima Yuji, Yoshizumi Tomoharu, Ikegami Toru, Harimoto Norifumi, Ito Shinji, Harada Noboru, Motomura Takashi, Nagatsu Akihisa, Ikeda Tetsuo, Maehara Yoshihiko
Departments of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Departments of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Anticancer Res. 2017 Jan;37(1):277-280. doi: 10.21873/anticanres.11318.
Surgical resection of retrocaval giant pheochromocytomas (PCs) and of extra-adrenal paragangliomas (EAPs) is a technically challenging procedure but data on these procedures are scarce. The purpose of this study was to present and evaluate our surgical results for such tumors.
We retrospectively analyzed four consecutive patients who had surgery for giant retro-caval PCs and EAPs in terms of surgical technique, resectability of the tumor, requirement for bypass, and postoperative complications. A laparoscopic approach was not feasible in all cases because of the undesirable location of the tumors.
In all cases, the liver was completely mobilized from the right side to expose and control the supra- and infra-hepatic inferior vena cava. Resection of the tumors was feasible for all patients with a minimum titration of blood pressure during surgery. None of the cases required venous bypass. In the patient who had the largest tumor, the infra-hepatic inferior vena cava was transected temporally to obtain direct and maximum exposure of the tumor. None of the patients have had any postoperative complications and all are currently alive without recurrence and use of antihypertensive drugs.
Resection of retrocaval giant PCs and EAPs is a safe procedure. Temporal transection of the infra-hepatic inferior vena cava can offer excellent exposure, especially for an extremely large tumor, without compromising hepatic and systemic hemodynamics.
腔静脉后巨大嗜铬细胞瘤（PCs）和肾上腺外副神经节瘤（EAPs）的手术切除是一项技术上具有挑战性的操作，但关于这些手术的数据很少。本研究的目的是介绍并评估我们对这类肿瘤的手术结果。
我们回顾性分析了连续4例接受腔静脉后巨大PCs和EAPs手术的患者，内容包括手术技术、肿瘤的可切除性、是否需要旁路以及术后并发症。由于肿瘤位置不理想，并非所有病例都可行腹腔镜手术。
在所有病例中，均将肝脏从右侧完全游离以暴露并控制肝上下腔静脉和肝下下腔静脉。所有患者的肿瘤均可行切除，术中血压波动最小。无一例需要静脉旁路。在肿瘤最大的患者中，暂时横断肝下下腔静脉以直接并最大程度地暴露肿瘤。所有患者均无术后并发症，目前均存活，无复发且未使用降压药物。
腔静脉后巨大PCs和EAPs的切除是一种安全的手术。暂时横断肝下下腔静脉可提供良好的暴露，特别是对于极大的肿瘤，且不影响肝脏和全身血流动力学。
