Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2018; 24(22): 2406-2412
Published online Jun 14, 2018. doi: 10.3748/wjg.v24.i22.2406
Devascularization of the superior mesenteric vein without reconstruction during surgery for retroperitoneal liposarcoma: A case report and review of literature
Run-Chen Miao, Yong Wan, Xiao-Gang Zhang, Xing Zhang, Yan Deng, Chang Liu
Run-Chen Miao, Yong Wan, Xiao-Gang Zhang, Xing Zhang, Yan Deng, Chang Liu, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Author contributions: Miao RC participated in the surgery and wrote the paper; Zhang XG and Deng Y manage patients and designed the research; Wan Y and Zhang X constructed figures; Liu C designed the research and became the chief surgeon.
Supported by the National Natural Science Foundation of China, No. 81773128 and No. 81472247; Project of Provincial Key Basic Research, No. 2017ZDJC-08 and No. 2016SF-204; and Clinical Research Project of The First Affiliated Hospital of Xi’an Jiaotong University, No. XJTU1AF-CRF-2015-003 and No. XJTU1AF-CRF-2015-011.
Informed consent statement: The patient provided written informed consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chang Liu, MD, PhD, Professor, Surgeon, Department of Hepatobiliary Surgery, The First Affiliated Hospital Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China. liuchangdoctor@163.com
Telephone: +86-18991232095 Fax: +86-29-82654746
Received: March 9, 2018
Peer-review started: March 10, 2018
First decision: April 11, 2018
Revised: April 18, 2018
Accepted: April 23, 2018
Article in press: April 23, 2018
Published online: June 14, 2018
Processing time: 93 Days and 15.3 Hours
Abstract

A 61-year-old female patient with chronic hepatitis B virus infection was diagnosed with liposarcoma in a community hospital. Fine needle aspiration biopsy confirmed the diagnosis of well-differentiated liposarcoma. Abdominal computed tomographic angiography (CTA) showed that the mass adhered to and constricted the main trunk and branch of the superior mesenteric vein (SMV), especially the ileocolic vein, and collateral circulation was observed during the vascular reconstruction scan. The abdominal liposarcoma was resected. Because of the collateral circulation, devascularization of the SMV was attempted, and we resected the eroded SMV. The condition of the blood vessels was evaluated 20 d after surgery using CTA, which showed that the SMV had disappeared. Significant improvements in SMV collateral circulation and the inferior mesenteric vein were observed after vascular reconstruction. The patient had an uneventful postoperative course except for transient gastroplegia. Twenty months after surgery, the patient had a recurrence of liposarcoma. She underwent tumor resection to remove the distal small intestine and right hemicolon. We learned that (1) direct devascularization of the main SMV trunk without a vein graft is possible. The presence of collateral circulation can increase the success rate of patients undergoing radical surgery and prevent the occurrence of serious postoperative complications. In addition, (2) this case demonstrated the clinical value of 3D reconstruction.

Keywords: Superior mesenteric vein; Retroperitoneal liposarcoma; Surgery

Core tip: A large liposarcoma adhered to and constricted the main trunk and branches of the superior mesenteric vein (SMV). Because of the existence of the collateral circulation, which had been observed by computed tomographic angiography, we resected the eroded SMV and devascularized it without vein grafting. In the case, we were aware of the clinical value of 3D reconstruction, and we believed that the collateral circulation could replace the function of SMV. Moreover, the collateral circulation may have ensured this patient’s postoperative survival. However, the actual condition for the formation of collateral circulation must be explored further.