Surgical Strategies for Retrocaval Paragangliomas: A Two-Case Series
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Paragangliomas (PGLs) are rare extra-adrenal neuroendocrine tumours, most commonly arising in the retroperitoneum, with retrocaval location being an exceptional and surgically demanding presentation. Complete surgical excision is the only curative treatment for non-metastatic lesions. The proximity to major vascular structures and the narrow operative space make surgical excision of retrocaval tumors technically challenging. Only 15 cases have been reported to date, most managed through open surgery. In this case series, we present two cases of retrocaval PGLs, with similar preoperative workup but different surgical approaches (one case treated by laparotomy and the other by laparoscopy). Considerations regarding the safety of minimally invasive approaches are discussed, and we present a technical strategy (“Hanging Maneuver”) for safer tumor manipulation. Minimally invasive approaches can be safely performed for selected retrocaval PGLs. Careful preoperative planning, atraumatic dissection techniques, and the use of adjunct maneuvers such as tumor suspension may facilitate complete resection and optimize surgical outcomes in this challenging location.
Abstract
Paragangliomas (PGLs) are rare extra-adrenal neuroendocrine tumours, most commonly arising in the retroperitoneum, with retrocaval location being an exceptional and surgically demanding presentation. Complete surgical excision is the only curative treatment for non-metastatic lesions. The proximity to major vascular structures and the narrow operative space make surgical excision of retrocaval tumors technically challenging. Only 15 cases have been reported to date, most managed through open surgery. In this case series, we present two cases of retrocaval PGLs, with similar preoperative workup but different surgical approaches (one case treated by laparotomy and the other by laparoscopy). Considerations regarding the safety of minimally invasive approaches are discussed, and we present a technical strategy (“Hanging Maneuver”) for safer tumor manipulation. Minimally invasive approaches can be safely performed for selected retrocaval PGLs. Careful preoperative planning, atraumatic dissection techniques, and the use of adjunct maneuvers such as tumor suspension may facilitate complete resection and optimize surgical outcomes in this challenging location.