Successful para‐aortic lymph node dissection for endometrial cancer with horseshoe kidney: A case report and review of the literature

• Published in: The journal of obstetrics and gynaecology research Vol. 45; no. 10; pp. 2128 - 2131
• Main Authors: Murakami, Atsushi, Amano, Tsukuru, Seko‐Nitta, Ayumi, Takahashi, Akimasa, Kimura, Fuminori, Murakami, Takashi
• Format: Journal Article
• Language: English
• Published: Kyoto, Japan John Wiley & Sons Australia, Ltd 01.10.2019; Wiley Subscription Services, Inc
• Subjects: Aorta; Biopsy; Carcinoma - surgery; Case reports; Computed tomography; Dissection; Endometrial cancer; Endometrial Neoplasms - surgery; Endometrium; Female; Fused Kidney - diagnostic imaging; Hemorrhage; horseshoe kidney; Humans; Hysterectomy; Kidneys; Literature reviews; lymph node dissection; Lymph Node Excision; Lymph nodes; lymphadenectomy; Lymphatic system; Middle Aged; Pelvis; Renal artery; Supernumerary; Tomography, X-Ray Computed; Ureter; horseshoe kidney; endometrial cancer; renal artery; lymph node dissection; lymphadenectomy
• ISSN: 1341-8076; 1447-0756
• DOI: 10.1111/jog.14050

Horseshoe kidney (HSK) is considered to impede para‐aortic lymph node dissection. We report the case of a 54‐year‐old female patient with endometrial cancer and HSK, treated successfully with para‐aortic lymph node dissection, and present literature review regarding vascular abnormalities associated with HSK affecting para‐aortic lymph node dissection. Three‐dimensional computed tomography reconstruction revealed the accessory renal artery, supernumerary renal vein and ventral displacement of the renal pelvis and ureter. Abdominal modified radical hysterectomy, bilateral salpingo‐oophorec'tomy, pelvic and para‐aortic lymph node dissection and omentectomy were then performed. Lymphadenectomy behind the isthmus of the kidney was performed without separation of the isthmus by lifting the kidneys with vessel tape. There were no intraoperative or postoperative complications. Grasping shifted ureter and complicated vascular network of HSK and securing the operative field without division of the isthmus were key to reducing complications and hemorrhage. This case report can serve as a guide for performing para‐aortic lymph node dissection safely and effectively in patients with HSK.