Elective suprarenal and infrarenal cavectomy for excision of giant retroperitoneal teratoma in infancy.

Retroperitoneal teratomas are rare, often massive tumors usually presenting in infancy; being mostly mature lesions, their treatment is surgical but may represent a formidable challenge. Major vessel displacement may not be well demonstrated on imaging: vascular injuries are well-recognized surgical complications with urgent repair, ligation, or even segmental excision of major vessels being required. However, the literature provides few suggestions to avoid these problems. In our approach, we assessed the important effaced abdominal veins on imaging and at laparotomy to allow us to electively excise the suprarenal and infrarenal vena cava (with both renal vein ostia) and thereby resect a giant retroperitoneal teratoma without inadvertent vessel injury, major bleeding, renal disturbance, or tumor recurrence. Described for renal tumors, elective cavectomy has not been reported as a technique to manage primary retroperitoneal teratomas. In selected cases, with careful preservation of renal venous collaterals, we show this can be a well-tolerated, preemptive option to reduce the high risks of surgical complications.