Anatomical basis for Wilms tumor surgery

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Abstract

Wilms tumor surgery requires meticulous planning and sophisticated surgical technique. Detailed anatomical knowledge can facilitate the uneventful performance of tumor nephrectomy and cannot be replaced by advanced and sophisticated imaging techniques. We can define two main goals for surgery: (1) exact staging as well as (2) safe and complete resection of tumor without spillage. This review aims to review the anatomical basis for Wilms tumor surgery. It focuses on the surgical anatomy of retroperitoneal space, aorta, vena cava and their large branches with lymphatics. Types and management of vascular injuries are discussed.

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Most cited references 34

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Level of Arterial Ligation in Rectal Cancer Surgery: Low Tie Preferred over High Tie. A Review

Marilyne Lange, Mark Buunen, Cornelis Van de Velde … (2008)

Consensus does not exist on the level of arterial ligation in rectal cancer surgery. From oncologic considerations, many surgeons apply high tie arterial ligation (level of inferior mesenteric artery). Other strategies include ligation at the level of the superior rectal artery, just caudally to the origin of the left colic artery (low tie), and ligation at a level without any intraoperative definition of the inferior mesenteric or superior rectal arteries. Publications concerning the level of ligation in rectal cancer surgery were systematically reviewed. Twenty-three articles that evaluated oncologic outcome (n = 14), anastomotic circulation (n = 5), autonomous innervation (n = 5), and tension on the anastomosis/anastomotic leakage (n = 2) matched our selection criteria and were systematically reviewed. There is insufficient evidence to support high tie as the technique of choice. Furthermore, high tie has been proven to decrease perfusion and innervation of the proximal limb. It is concluded that neither the high tie strategy nor the low tie strategy is evidence based and that low tie is anatomically less invasive with respect to circulation and autonomous innervation of the proximal limb of anastomosis. As a consequence, in rectal cancer surgery low tie should be the preferred method.

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Riolan's arch: confusing, misnomer, and obsolete. A literature survey of the connection(s) between the superior and inferior mesenteric arteries.

E Nout, Sébastien F. Lange, F Schlesinger … (2007)

There are 2 interpretations of Riolan's arch: (1) Riolan's arch is identical to a central part of the marginal artery (MA), connecting the superior (SMA) and the inferior mesenteric (IMA) arteries; and (2) Riolan's arch represents a rare artery, connecting the SMA and the IMA. The current review aims to emphasize the clinical importance of the colon's vasculature and to show the feasibility of abolishing the terms "Riolan's arch" and "meandering mesenteric artery." A literature survey was performed. It appears that no distinct identity can be ascribed to Riolan's arch and that the "meandering mesenteric artery" represents an angiographically hypertrophied MA and/or the ascending branch of the left colic artery. However, a rare, centrally located, communicating artery has been described. Generally, the MA is sufficient for left colic circulation after ligation of the IMA, but at the splenic flexure, patency of the ascending branch of the left colic artery can be primordial. As connections between the SMA and the IMA can be adequately described using structures mentioned in Terminologica Anatomica, the terms "Riolan's arch" and "meandering mesenteric artery" should be abolished.

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Anomalies of the inferior vena cava and renal veins: embryologic and surgical considerations.

E Fishman, Wallace F. Marshall, R Mathews … (1999)

Anomalies of the inferior vena cava and renal veins occur infrequently but if unidentified can lead to significant morbidity during surgical exploration. An understanding of the embryologic development of the vena cava and its tributaries is necessary to understand the genesis of these sometimes complex anomalies and their accompanying anatomic variants. Newer radiologic modalities in the form of spiral computed tomography (CT) and three-dimensional reconstruction of spiral CT allow clear definition of the anatomy of these anomalies. Variations in the embryologic evolution of the vena cava dictate the different venous anomalies that may be encountered in the retroperitoneum. Additionally, the utility of newer radiologic modalities in the identification of these anomalies is discussed.

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Author and article information

Journal

Journal ID (nlm-ta): J Indian Assoc Pediatr Surg

Journal ID (publisher-id): IJAPS

Title: Journal of Indian Association of Pediatric Surgeons

Publisher: Medknow Publications (India )

ISSN (Print): 0971-9261

ISSN (Electronic): 1998-3891

Publication date (Print): Apr-Jun 2009

Volume: 14

Issue: 2

Pages: 50-54

Affiliations

Department of Pediatric Surgery, Catholic Foundation Marien Hospital, Ruhr-University of Bochum, Herne, Germany

Author notes

Address for correspondence: Dr. Ralf-Bodo Tröbs, Department of Paediatric Surgery, Catholic Foundation Marien Hospital Herne, Ruhr-University of Bochum, D-44627 Herne, Widumer Str. 8, Germany. E-mail: ralf-bodo.troebs@ 123456marienhospital-herne.de

Article

Publisher ID: JIAPS-14-50

DOI: 10.4103/0971-9261.55151

PMC ID: 2905530

PubMed ID: 20671845

SO-VID: b57265ba-368f-4285-a17f-125821a87fb1

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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