Variants of the anatomy of the renal vascular bed in patients with retroperitoneal germ cell tumors

Background. Renovascular anatomy is characterized by complex morphological variations in relation to the number, origin level, length, diameter and topographic relationships of the vessels. Understanding of individual vascular anatomy during the planning of surgical intervention in the retroperitoneal space allows to decrease technical difficulty and achieve better perioperative results.

Aim. To study frequencies of renal vessel variant anatomies that can become intraoperative finds in patients with germ cell tumors of the retroperitoneal location due to incomplete preoperative examination creating technical difficulties during surgical treatment.

Materials and methods. At the first stage, comparison of a group of 407 patients with germ cell tumors with a control group (401 patients with other oncological diseases) by the presence of vascular anomalies was performed. The second stage consisted of intragroup analysis of operative time, blood loss volume and complications in patients after retroperitoneal lymph node dissection depending on the identified vascular anomaly.

Results. Anomalies of renal arteries were identified in 73.2 % of cases in the germ cell tumor group which significantly differed from the control group value of 24.9 % (р = 0.001). The frequency of renal vein anomalies in germ cell tumors was 69.0 % compared to 12.5 % in the control group (р < 0.05). Median operative time in the total group was 217.2 ± 0.7 min. Statistically significant differences in increase of operative time in the presence of additional arteries (р = 0.001) and veins (р = 0.002) were observed. Total mean blood loss volume was 389 ± 51.4 mL. Intraoperative blood loss volume significantly depended on injury of additional arteries (р = 0.003) and veins (р = 0.002). Intraoperative complications associated with injury of the main large vessels were observed in 18.7 % of cases. Clinically significand trend was observed towards decreased intraoperative injury of additional and main vessels (total number of injuries 36 (8.9 %) and 76 (18.7 %), respectively; р = 0.017) and, therefore, decreased risk of surgical complications after accumulation of experience in retroperitoneal lymph node dissection and introduction of computed tomography with 3D reconstruction of renal vessels in 2018.

Conclusion. Frequency and diversity of various vessels of the retroperitoneal space in patients with germ cell tumors require careful preoperative preparation of the patients in the form of topographic visualization of the vascular network.