Malignant pheochromocytoma resection

Case Description

This is the case of a 64-year-old man with a 13cm locally invasive malignant pheochromocytoma of the right adrenal gland, invading the right kidney, the caudate lobe of the liver, the vena cava and has tumor thrombus extending to the right atrium.
The abdomen is entered through a midline laparotomy with bilateral horizontal extensions.
Vascular pedicles of the right kidney are stapled early, as well as the right ureteric complex, and the tumor is mobilized with the right kidney.
A slinging maneuver behind all three hepatic veins is performed and the caudate lobe is dissected off the liver and kept en-bloc with the tumor and the cava.
The portal vein is cannulated in preparation of the cold perfusion and a tourniquet is used to encircle the porta.
Bovine pericardium is used to create tubular graft which are then connected to the infrarenal cava and the SMV. They are cannulated with Macquet catheters.
The right internal jugular vein is cannulated. Caval clamping and a Pringle maneuver are performed and the veno-veno bypass and hepatic cold perfusion are instituted.
The right kidney, right adrenal tumor, retrohepatic vena cava and caudate lobe are resected.
The vena cava was reconstructed with a ringed PTFE graft.
The cold perfusion is stopped and the tourniquet is released to reperfuse the liver.
A venting venotomy is made on the inferior cava to flush the preservation solution.
The clamps are removed,the veno-veno bypass stopped and the tubular grafts are stapled off.