V11-06: Laparoscopic resection of paraaortic or paracaval neurogenic tumors

Video

Introductions and Objectives
Based on experiences of laparoscopic adrenalectomy, nephrectomy, and retroperitoneal lymph node dissection, the indication of laparoscopic surgery has now broadened the management of rare retroperitoneal tumors. This study describes the authors’ experience and tips and advice for laparoscopic resection of paraaortic or paracaval neurogenic tumors.

Methods
Between 2000 and 2014, 24 procedures were performed in 23 patients [male/ female = 11/12, median of 33 years old (range, 14-78)]. One patient underwent second surgery due to the recurrence of paraganglioma. Data were collected on the tumor diameter, tumor location, perioperative outcomes, pathology, and last known disease status. Regarding the operative procedures, we reviewed the operative records or videos to identify tips and advice regarding surgery for this entity.

Results
The median tumor diameter was 5.3 cm (range, 1.5-10). The tumor location was suprahilar in 10, hilar in 5, and infrahilar in 9. Regarding the approach, a transperitoneal approach was selected in 21 cases, transperitoneal approach plus retroperitoneal balloon dilation in 2, and retroperitoneal approach in 1. The median operative time and blood loss were 206 minutes (range, 73-513) and 10 mL (range, 0-1,020), respectively. No patient required blood transfusion or conversion to open surgery. Pathological examination revealed paraganglioma in 11, ganglioneuroma in 7, and schwannoma in 6. At the last follow-up, 22 patients were free of disease, while one patient developed metastatic recurrence of paraganglioma. A review of the records revealed several tips, including taping the vena cava/ renal vein (n=2) for tumor dissection or rotating the kidney to approach the tumor behind renal hilum (n=2). In several cases, 3D-CT was helpful for preoperative planning.

Conclusions
Laparoscopic resection of paraaortic or paracaval neurogenic tumors is feasible. Surgeons should be familiar with dissection around great vessels and the mobilization of adjacent organs. Careful preoperative planning, including 3D-CT, is important.

Funding: none