Aortic Replacement for Retroperitoneal Tumors in Children

Abstract

1. Abstract Retroperitoneal tumors may involve the abdominal aorta. Sometimes, these tumors are unresponsive to adjuvant therapy. The total resection is a challenge mainly for vascular reconstruction in children. Then, we report three cases of aortic replacement in children with retroperitoneal tumors. Case 1: an eight-year-old girl presenting with a ganglioneuroma involving the aorta. The tumor was resected with an abdominal aorta segment, which was replaced by an aortoaortic prosthesis. Case 2: a 13-year-old boy was presented with a paraganglioma involving the aortic bifurcation, requiring resection and replacement by aortoiliac bypass. Case 3: an 11-year-old girl with abdominal neurofibromatosis. During the resection, the aorta and left iliac artery were replaced by an aortoiliac graft. Resection of a segment of the aorta and revascularization using a prosthesis is feasible in retroperitoneal tumors in children, but the long-term results are unknown. 2. Introduction Retroperitoneal tumors in children may involve or surround the abdominal aorta and its main branches. Such vascular involvement leads to challenging surgical procedures and may be considered unresectable. When large tumors involve major vascular trunks and do not respond to chemotherapy, resection of the tumor with replacement of the aorta may be an alternative. Replacement of the abdominal aorta in children is a complex procedure that is rarely performed. In children, synthetic grafts are limited by a concern for late infection and lack of potential growth. There are few reports on this in the literature. We report three cases of children with retroperitoneal tumors, in which replacement of the aorta was needed in order to resect the tumor. 3. Patients and Methods Cases came from two reference institutions for pediatric oncology, pediatric surgical oncology, and vascular surgery. Three cases in which tumor resection was performed with replacement of the aorta or its branches were found, who underwent three procedures. 4. Case 1 An eight-year-old girl, presented with abdominal mass for 10 months and deficit of growth for two years. Ultrasound (US) and computed tomography (CT) revealed a mass involving the aorta, celiac trunk, mesenteric artery, and left renal hilum (Figure 1). Initial biopsy revealed a ganglioneuroma. Due to tumor dimension and suspecting that there might be concomitant malignant parts within the tumor that might not have been not sampled at the initial biopsy, a partial resection (debulking) procedure was indicated. During this procedure, the aorta and superior mesen-