1314 Renovascular Variations During Retroperitoneal Lymphadenectomy: Structure and Outcomes

Introduction/Background To investigate the structure, type, localization and number of renovascular variations detected during retroperitoneal lymphadenectomy with surgical outcomes. Methodology 100 consecutive pelvic and paraaortic lymphadenectomy procedures performed for various gynecologic cancer cases between January 2021 and April 2023 by single surgeon (gynecologic cancer surgeon and anatomist) were retrospectively analyzed from the prospectively documented patient files, operation photos and videos. All patients had standardized pelvic and paraaortic lymphadenectomy procedure. Results The prevalence of renovascular variations was 28% (28/100patients.) In 17 patients isolated arterial variation, in 8/28 isolated venous variation and in 3/28 both arterial and venous variation were detected. The most common variation was caudally originating renal artery (10/28, 35.7%), which is arising lower than the classical Lumbar 1–2 vertebra level, and secondly the supernumerary (additional) renal artery (8/28, 28.5%) was detected. In 16 patients (57.1%) the variations were related to the left side and in 8 patients (28.5%) to the right side. Three of the supernumerary renal arteries were towards the left kidney, arising from the lateral surface of the aorta, and the remaining 5 were towards the right kidney, arising from the anterior or anterolateral surface of the aorta. Variations lying at both the inter-aortocaval and supramesenteric lateral aortic area (9/28,32.1%) were the most common ones. Followingly, they were detected at the supramesenteric lateral aortic area (isolatedly) (8/28,28.5%) and precaval area (5/28). The most common venous variation was retroaortic left renal vein (6/28), additionally the circumaortic renal vein and double inferior vena cava were also noted. In 1 patient the caudally originating renal artery was ligated during surgery, and vascular graft anastomosis was performed without any complication. Conclusion During paraaortic lymphadenectomy, the surgeon should make a meticulous dissection at the supramesenteric lateral aortic and supramesenteric inter-aortocaval area. Disclosures None.