En Bloc Mobilization of the Pancreas and Spleen to Facilitate Resection of Large Tumors, Primarily Renal and Adrenal, in the Left Upper Quadrant of the Abdomen

Techniques Derived from Multivisceral Transplantation

Gaetano Ciancio, Anil Vaidya, Samir Shirodkar, Murugesan Manoharan, Tariq Hakky, Mark Soloway

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: The left upper quadrant of the abdomen may be occupied by a wide range of urologic pathology. When these lesions are large, safely resecting them often presents a significant technical challenge, with the possibility of resultant morbidity and mortality. Objective: We describe a technique derived from our experience with multivisceral transplant and organ procurement, which provides excellent exposure of this anatomic region. Design, setting, and participants: From May 1999 to April 2006, 70 patients underwent en bloc mobilization of the spleen and the pancreas and, as necessary, the stomach for masses in the left upper retroperitoneum. Pathology included malignant and benign lesions, including renal cell carcinoma (RCC) with or without inferior vena cava (IVC) involvement, adrenal tumors, retrocrural lymphadenopathy from testicular cancer, and transitional cell carcinoma of the renal pelvis. Surgical procedure: An extended subcostal transabdominal approach was used to resect large tumors in the left upper abdomen. This approach offers significant advantages over conventional approaches, including a flank, thoracoabdominal, or midline transabdominal incision with reflection of the descending colon. Measurements: Intraoperative variables, including operative time, blood loss, transfusion rate, and extent of mobilization were recorded. Postoperative complications, including prolonged intubation, ileus, and deep venous thrombosis were also noted. Results and limitations: Mean estimated blood loss during surgery was 973 ml. There were no perioperative deaths. No patients had pancreatitis or acute renal failure. Deep venous thrombosis was not seen. Cardiopulmonary bypass was used in one patient with an atrial thrombus. At a median follow-up of 42 mo, two patients died due to metastasis. Conclusions: Techniques acquired from organ harvesting as well as our experience at multivisceral transplant, such as en bloc mobilization of the spleen, pancreas, and stomach, can be utilized safely and effectively to gain excellent exposure to the left upper retroperitoneum via an extended subcostal incision with no additional morbidity for the patient.

Original languageEnglish
Pages (from-to)1106-1111
Number of pages6
JournalEuropean Urology
Volume55
Issue number5
DOIs
StatePublished - May 1 2009

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Abdomen
Pancreas
Spleen
Transplantation
Kidney
Neoplasms
Venous Thrombosis
Stomach
Tissue and Organ Harvesting
Pathology
Morbidity
Descending Colon
Transplants
Kidney Pelvis
Tissue and Organ Procurement
Glandular and Epithelial Neoplasms
Ileus
Transitional Cell Carcinoma
Testicular Neoplasms
Inferior Vena Cava

Keywords

  • En bloc mobilization
  • Transplantation
  • Urological tumors

ASJC Scopus subject areas

  • Urology

Cite this

En Bloc Mobilization of the Pancreas and Spleen to Facilitate Resection of Large Tumors, Primarily Renal and Adrenal, in the Left Upper Quadrant of the Abdomen : Techniques Derived from Multivisceral Transplantation. / Ciancio, Gaetano; Vaidya, Anil; Shirodkar, Samir; Manoharan, Murugesan; Hakky, Tariq; Soloway, Mark.

In: European Urology, Vol. 55, No. 5, 01.05.2009, p. 1106-1111.

Research output: Contribution to journalArticle

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abstract = "Background: The left upper quadrant of the abdomen may be occupied by a wide range of urologic pathology. When these lesions are large, safely resecting them often presents a significant technical challenge, with the possibility of resultant morbidity and mortality. Objective: We describe a technique derived from our experience with multivisceral transplant and organ procurement, which provides excellent exposure of this anatomic region. Design, setting, and participants: From May 1999 to April 2006, 70 patients underwent en bloc mobilization of the spleen and the pancreas and, as necessary, the stomach for masses in the left upper retroperitoneum. Pathology included malignant and benign lesions, including renal cell carcinoma (RCC) with or without inferior vena cava (IVC) involvement, adrenal tumors, retrocrural lymphadenopathy from testicular cancer, and transitional cell carcinoma of the renal pelvis. Surgical procedure: An extended subcostal transabdominal approach was used to resect large tumors in the left upper abdomen. This approach offers significant advantages over conventional approaches, including a flank, thoracoabdominal, or midline transabdominal incision with reflection of the descending colon. Measurements: Intraoperative variables, including operative time, blood loss, transfusion rate, and extent of mobilization were recorded. Postoperative complications, including prolonged intubation, ileus, and deep venous thrombosis were also noted. Results and limitations: Mean estimated blood loss during surgery was 973 ml. There were no perioperative deaths. No patients had pancreatitis or acute renal failure. Deep venous thrombosis was not seen. Cardiopulmonary bypass was used in one patient with an atrial thrombus. At a median follow-up of 42 mo, two patients died due to metastasis. Conclusions: Techniques acquired from organ harvesting as well as our experience at multivisceral transplant, such as en bloc mobilization of the spleen, pancreas, and stomach, can be utilized safely and effectively to gain excellent exposure to the left upper retroperitoneum via an extended subcostal incision with no additional morbidity for the patient.",
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AU - Ciancio, Gaetano

AU - Vaidya, Anil

AU - Shirodkar, Samir

AU - Manoharan, Murugesan

AU - Hakky, Tariq

AU - Soloway, Mark

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AB - Background: The left upper quadrant of the abdomen may be occupied by a wide range of urologic pathology. When these lesions are large, safely resecting them often presents a significant technical challenge, with the possibility of resultant morbidity and mortality. Objective: We describe a technique derived from our experience with multivisceral transplant and organ procurement, which provides excellent exposure of this anatomic region. Design, setting, and participants: From May 1999 to April 2006, 70 patients underwent en bloc mobilization of the spleen and the pancreas and, as necessary, the stomach for masses in the left upper retroperitoneum. Pathology included malignant and benign lesions, including renal cell carcinoma (RCC) with or without inferior vena cava (IVC) involvement, adrenal tumors, retrocrural lymphadenopathy from testicular cancer, and transitional cell carcinoma of the renal pelvis. Surgical procedure: An extended subcostal transabdominal approach was used to resect large tumors in the left upper abdomen. This approach offers significant advantages over conventional approaches, including a flank, thoracoabdominal, or midline transabdominal incision with reflection of the descending colon. Measurements: Intraoperative variables, including operative time, blood loss, transfusion rate, and extent of mobilization were recorded. Postoperative complications, including prolonged intubation, ileus, and deep venous thrombosis were also noted. Results and limitations: Mean estimated blood loss during surgery was 973 ml. There were no perioperative deaths. No patients had pancreatitis or acute renal failure. Deep venous thrombosis was not seen. Cardiopulmonary bypass was used in one patient with an atrial thrombus. At a median follow-up of 42 mo, two patients died due to metastasis. Conclusions: Techniques acquired from organ harvesting as well as our experience at multivisceral transplant, such as en bloc mobilization of the spleen, pancreas, and stomach, can be utilized safely and effectively to gain excellent exposure to the left upper retroperitoneum via an extended subcostal incision with no additional morbidity for the patient.

KW - En bloc mobilization

KW - Transplantation

KW - Urological tumors

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