Accompanying role of hepato-biliary-pancreas surgeon in urological surgery. (2017) - Nanashima, Atsushi
Highlights: Accompanying support by full use of procedure of general or cardiovascular surgeons for urological surgery in malignancies provide curability. Cardiovascular intervention should be necessary to remove long extension of tumor thrombus into the vena cava or right atrium. Hepatic or pancreatic mobilization or combined resection is required for invasive or metastatic urological malignancies. Operative safety is also required by precise preoperative planning and arrangement of procedure during operation by the good combination in each. Abstract: Introduction: The present case reports demonstrated the accompanying surgical support from hepato-biliary-pancreas (HBP) surgeons for urological surgery to secure operative safety because HBP surgeons are well experienced in dissecting techniques for mobilization of the liver or pancreas. We experienced 9 consecutive patients who underwent nephrectomy, adrenectomy or resection of retroperitoneal tumors by urological surgeons. Cardiovascular intervention was also required in cases of long tumor thrombus into the vena cava. Cases: All patients had no severe co-existing diseases except the main tumor. Reverse T-shape incision was performed in 7 cases and thoracolaparotomy in two. Dissection and mobilization at the site of severe compression by the urinary tumors were performed in three cases. Partial liver resection was performed for testicular liver metastases in two, and right hepatectomy for right renal cancer was performed in one. Encircling the vena cava and preparation of transection for tumor thrombi were performed in three, and among these, cardiovascular intervention was necessary in two because of extension into the right atrium. During admission, all patient outcomes were uneventful without severe complications. We herein showed the representative two cases of combined surgery. Discussion: and conclusion The point of this case report is the coordination between each surgeon and anesthesiologist under precise perioperative planning or management. The role of HBP surgeons is to provide information as a specialist on the operative field for urological or cardiovascular surgery to achieve operative safety.