{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T21:11:48Z","timestamp":1779916308679,"version":"3.53.1"},"reference-count":17,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T00:00:00Z","timestamp":1754006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: The causes and clinical outcomes of renal perfusion abnormalities occurring after para-aortic lymphadenectomy (PANDx) for gynecologic malignancies are unknown. We investigated the potential involvement of accessory renal artery (ARA) obstruction in their development by reassessing perioperative contrast-enhanced computed tomography (CECT). Materials and Methods: This retrospective study investigated a clinical database to identify urinary contrast defects using CECT in all patients who had undergone PANDx between January 2020 and December 2024. The perfusion defects in the kidney detected by CECT were extracted by a gynecologic oncologist and evaluated by a radiologist and urologist for suspected obstruction of ARAs. Results: Postoperative renal contrast defects were observed in 3.8% (6\/157) of patients. Renal parenchymal fibrosis, cortical atrophy, and parenchymal thinning were observed as universal findings in all patients showing renal contrast defects. In five of the six cases, ARAs supplying the infarcted renal segments were identified on preoperative CECT, and arterial obstruction was confirmed on postoperative imaging. The remaining case was considered to be latent pyelonephritis. All five patients underwent laparotomy, and preoperative CECT failed to detect ARAs. The median resected para-aortic lymph node was 23 nodes (range: 15\u201333) in five patients, showing no statistically significant difference compared to patients without perfusion abnormalities (p = 0.19). Postoperative serum creatinine levels remained stable. Conclusions: ARA obstruction appears to be a risk factor for segmental renal infarction after para-aortic lymphadenectomy in gynecological malignancies; however, the clinical impact on urinary function may be limited. Awareness of this potential complication is essential for gynecologic oncologists performing PANDx.<\/jats:p>","DOI":"10.3390\/medicina61081395","type":"journal-article","created":{"date-parts":[[2025,8,1]],"date-time":"2025-08-01T06:37:47Z","timestamp":1754030267000},"page":"1395","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Segmental Renal Infarction Associated with Accessory Renal Arteries After Para-Aortic Lymphadenectomy in Gynecologic Malignancies"],"prefix":"10.3390","volume":"61","author":[{"given":"Ayumi","family":"Kozai","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima 890-8520, Japan"},{"name":"Department of Perinatology and Gynecology, Faculty of Medicine, Kagawa University, Kagawa 761-0793, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2297-6648","authenticated-orcid":false,"given":"Shintaro","family":"Yanazume","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima 890-8520, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6331-8796","authenticated-orcid":false,"given":"Fumitaka","family":"Ejima","sequence":"additional","affiliation":[{"name":"Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4224-5084","authenticated-orcid":false,"given":"Shuichi","family":"Tatarano","sequence":"additional","affiliation":[{"name":"Department of Urology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima 890-8520, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rintaro","family":"Kubo","sequence":"additional","affiliation":[{"name":"Course of Advanced Cancer Medicine for Gynecologic Cancer, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1920-9405","authenticated-orcid":false,"given":"Shinichi","family":"Togami","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima 890-8520, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2918-4336","authenticated-orcid":false,"given":"Takashi","family":"Yoshiura","sequence":"additional","affiliation":[{"name":"Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2491-2189","authenticated-orcid":false,"given":"Hiroaki","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima 890-8520, Japan"},{"name":"Course of Advanced Cancer Medicine for Gynecologic Cancer, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1136\/ijgc-2020-001248","article-title":"Quality indicators for advanced ovarian cancer surgery from the European Society of Gynaecological Oncology (ESGO): 2020 update","volume":"30","author":"Fotopoulou","year":"2020","journal-title":"Int. J. Gynecol. Cancer"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3406","DOI":"10.1245\/s10434-017-6031-z","article-title":"2017 Update on the Querleu-Morrow Classification of Radical Hysterectomy","volume":"24","author":"Querleu","year":"2017","journal-title":"Ann. Surg. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"252","DOI":"10.3802\/jgo.2015.26.4.252","article-title":"A critical assessment on the role of sentinel node mapping in endometrial cancer","volume":"26","author":"Bogani","year":"2015","journal-title":"J. Gynecol. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Kostov, S., Selcuk, I., Yordanov, A., Kornovski, Y., Yalcin, H., Slavchev, S., Ivanova, Y., Dineva, S., Dzhenkov, D., and Watrowski, R. (2022). Paraaortic Lymphadenectomy in Gynecologic Oncology-Significance of Vessels Variations. J. Clin. Med., 11.","DOI":"10.3390\/jcm11040953"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1007\/s10147-024-02635-8","article-title":"Robotic dual-docking surgery for para-aortic lymphadenectomy in endometrial cancer: A prospective feasibility study","volume":"30","author":"Yanazume","year":"2024","journal-title":"Int. J. Clin. Oncol."},{"key":"ref_6","first-page":"87","article-title":"Accessory polar renal artery encountered in transperitoneal systemic laparoscopic paraaortic lymphadenectomy","volume":"32","author":"Lee","year":"2011","journal-title":"Eur. J. Gynaecol. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/S0090-8258(03)00508-0","article-title":"Ligation of an anatomic variant of renal vasculature during laparoscopic periaortic lymph node dissection: A cause of postoperative renal infarction","volume":"91","author":"Eitan","year":"2003","journal-title":"Gynecol. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Yanazume, S., Kobayashi, Y., Kozai, A., Fukuda, M., Togami, S., Yoshiura, T., and Kobayashi, H. (2025). Potential preoperative three-dimensional computed tomography for para-aortic lymphadenectomy in gynecological malignancies. J. Obstet. Gynaecol. Res., 51.","DOI":"10.1111\/jog.16367"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.suronc.2020.09.008","article-title":"Learning curve of laparoscopic extraperitoneal para-aortic lymphadenectomy for endometrial carcinoma: A cumulative sum analysis","volume":"35","author":"Yoshida","year":"2020","journal-title":"Surg. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.2214\/AJR.12.9691","article-title":"Nephrographic and pyelographic analysis of CT urography: Principles, patterns, and pathophysiology","volume":"200","author":"Wolin","year":"2013","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1111\/j.1471-0528.2011.03171.x","article-title":"Systematic (complete) para-aortic lymphadenectomy: Description of a novel surgical classification with technical and anatomical considerations","volume":"119","author":"Pomel","year":"2012","journal-title":"BJOG"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"126","DOI":"10.4274\/tjod.23245","article-title":"Anatomic structure of the internal iliac artery and its educative dissection for peripartum and pelvic hemorrhage","volume":"15","author":"Selcuk","year":"2018","journal-title":"Turk. J. Obstet. Gynecol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1002\/ccr3.3493","article-title":"Encountering the accessory polar renal artery during retroperitoneal lymphadenectomy","volume":"9","author":"Karadag","year":"2021","journal-title":"Clin. Case Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1148\/radiographics.21.2.g01mr19373","article-title":"Three-dimensional volume-rendered CT angiography of the renal arteries and veins: Normal anatomy, variants, and clinical applications","volume":"21","author":"Urban","year":"2001","journal-title":"Radiographics"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1148\/radiol.2353040496","article-title":"Multi-detector row CT in evaluation of 94 living renal donors by readers with varied experience","volume":"235","author":"Sahani","year":"2005","journal-title":"Radiology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/S1074-3804(00)80009-2","article-title":"Learning curves for transperitoneal laparoscopic and extraperitoneal endoscopic paraaortic lymphadenectomy","volume":"7","author":"Occelli","year":"2000","journal-title":"J. Am. Assoc. Gynecol. Laparosc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/S0720-048X(01)00476-4","article-title":"CT features of renal infarction","volume":"44","author":"Suzer","year":"2002","journal-title":"Eur. J. Radiol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/8\/1395\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:20:42Z","timestamp":1760034042000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/8\/1395"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,1]]},"references-count":17,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["medicina61081395"],"URL":"https:\/\/doi.org\/10.3390\/medicina61081395","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,1]]}}}