Complete and safe resection of challenging retroperitoneal tumors: anticipation of multi-organ and major vascular resection and use of adjunct procedures

Abstract

BackgroundRetroperitoneal tumors are often massive and can involve adjacent organs and/or vital structures, making them difficult to resect. Completeness of resection is within the surgeon's control and critical for long-term survival, particularly for malignant disease. Few studies directly address strategies for complete and safe resection of challenging retroperitoneal tumors.MethodsFifty-six patients representing 63 cases of primary or recurrent retroperitoneal tumor resection between 2004-2009 were identified and a retrospective chart review was performed. Rates of complete resection, use of adjunct procedures, and perioperative complications were recorded.ResultsIn 95% of cases, complete resection was achieved. Fifty-eight percent of these cases required en bloc multi-organ resection, and 8% required major vascular resection. Complete resection rates were higher for primary versus recurrent disease. Adjunct procedures (ureteral stents, femoral nerve monitoring, posterior laminotomy, etc.) were used in 54% of cases. Major postoperative complications occurred in 16% of cases, and one patient died (2% mortality).ConclusionsComplete resection of challenging retroperitoneal tumors is feasible and can be done safely with important pre- and intraoperative considerations in mind.

Luteinizing hormone, sex steroids and extracorporeal circulation – A promising link to treat retroperitoneal sarcomas. A reconsideration of cancer treatment

“…In the absence of complex vascular interventions, associating a high level of risk, the rate of radical resections is low and therefore patient survival is poor. A few surgical teams have adopted an aggressive attitude with ample vascular resections followed by laborious reconstructions [36,37]. However, even an experienced multidisciplinary team will consider these interventions too complex.…”

A case of retroperitoneal tumor – clinical and therapeutic considerations

“…This fact has the disadvantage that during reassessments some tumors that are initially classified as benign, its need to be reclassified as malignant following the detection of metastases [11].…”

Complete Surgical Resection of a Leiomyosarcoma Arising from the Inferior Vena Cava

“…In spite of leiomyosarcomas being slow-growing and having late metastasis, leiomyosarcomas carry a poor prognosis and a high incidence of local recurrence. The most important prognostic factor is the ability to surgically achieve a microscopically negative margin [ 11 ]. The 5-year survival rate has been reported to be approximately 50% after complete en bloc resection [ 4 , 5 ].…”