Department of Urologic Surgery, University of California at Davis, Sacramento, CA, USA.
Department of Vascular Surgery, University of California at Davis, Sacramento, CA, USA.
Eur Urol Oncol. 2020 Feb;3(1):1-6. doi: 10.1016/j.euo.2019.11.004. Epub 2019 Dec 28.
The incidence of complications for postchemotherapy (PC) resections is high. Severe intraoperative hemorrhage during retroperitoneal lymph node dissection is of significant concern. The safety and efficacy of endovascular technology in vascular surgery have been demonstrated, but no studies have incorporated endovascular stenting in preoperative planning. We present a case series of four patients with nonseminomatous germ cell tumors who underwent preoperative endovascular stenting to identify and protect major vascular structures encased by complex PC tumors. We measured operative time, estimated blood loss, intraoperative transfusion requirement, length of stay, and postoperative complications. In all cases, surgery progressed without full continuous identification of the major vascular structures and their branches because of the assurance that hemorrhage would be controlled should they be breached. PATIENT SUMMARY: Preoperative endovascular stenting may be an effective approach for minimizing intraoperative hemorrhage and operative time in patients undergoing bulky postchemotherapy dissection. Additional studies are needed to better clarify patient selection criteria and quantify the efficacy and adverse consequences.
化疗后（PC）切除术后并发症的发生率很高。腹膜后淋巴结清扫术中严重的术中出血令人高度关注。血管外科中的血管内技术的安全性和有效性已经得到证实，但没有研究将血管内支架置入术纳入术前计划。我们报告了 4 例非精原细胞瘤生殖细胞肿瘤患者的病例系列，他们接受了术前血管内支架置入术，以识别和保护被复杂 PC 肿瘤包裹的主要血管结构。我们测量了手术时间、估计失血量、术中输血需求、住院时间和术后并发症。在所有情况下，由于有信心如果主要血管结构及其分支破裂，出血将得到控制，因此手术在没有完全连续识别主要血管结构及其分支的情况下进行。患者总结：术前血管内支架置入术可能是一种有效的方法，可以减少接受大体积化疗后解剖的患者的术中出血和手术时间。需要进一步的研究来更好地阐明患者选择标准，并量化疗效和不良后果。
