Objective To summarize the experience in diagnosis and treatment of primary retroperitoneal tumor (PRT). Methods Clinical data of 69 patients with PRT from June 1998 to June 2008 were analyzed retrospectively. Results Bellyache, abdominal distention, and abdominal mass were common symptoms in the patients with PRT. Ultrasound, CT, and MRI examination were effective. The major histopathological classification was soft tissue tumor, germinoma, lymphatic hematopoietic system tumors, and other rare tumors. Complete resection of tumors was performed in 42 cases, combined organs resection in 10 cases, partial resection of tumors in 11 cases, and only biopsy in 6 cases. There were 10 cases of intraoperative vessel and organ injury, which were treated by repair or vessels suturing and combined organ resection. Postoperative complications occurred in 8 cases, which were cured by conservative treatment. One patient died of hemorrhage acute stress ulcer combined multiple organ failure. The survival rates of 1, 3, and 5 years in patients underwent complete resection of tumors were 71%, 64%, and 46%, respectively. Of 11 patients underwent partial resection of tumors, 8 cases died within one year, and 3 cases died within 3 years after operation. All malignant tumor patients treated by biopsy died within one year after operation.Conclusion Synthetically using imaging examination may diagnose definitely, and to resect tumors as much as possible will improve patients’ survival.
This study aims to explore the inferior adhesion of the renal fascia (RF), and the inferior connectivity of the perirenal spaces (PS) with multidetector computed tomography (MDCT), and to investigate the diagnostic value of CT for showing this anatomy. From May to July 2012, eighty-two patients with acute pancreatitis presented in our hospital were enrolled into this study and underwent contrast-enhanced CT scans. All the image data were used to perform three dimensional reconstruction to show the inferior attachment of RF and the inferior connectivity of PS. The fusion of anterior renal fascia (ARF) and posterior renal fascia (PRF) next to the plane of iliac fossa were found on the left in 71.95% (59/82) cases, and on the right in 75.61% (62/82). In these cases, bilateral perirenal spaces, and anterior and posterior pararenal spaces were not found to be connected with each other. No fusion of ARF and PRF below the level of bilateral kidneys occurred on the left side in 28.05% (23/82) cases and on the right side in 24.39% (20/82). In these patients, the PS extended to the extraperitoneal space of the pelvic cavity and further to the inguinal region, and bilateral anterior and posterior pararenal spaces were not found to be connected with each other. Three-dimensional reconstruction on contrast-enhanced MDCT could be a valuable procedure for depicting inferior attachment of RF, and the inferior connectivity of PS.
ObjectiveTo evaluate the safety and feasibility of laparoscopic resection of primary retroperitoneal tumors. MethodClinical data of 52 patients diagnosed as primary retroperitoneal tumor who underwent laparoscopic resection in Peking University Third Hospital from January 2006 to December 2015 were retrospectively collected and analyzed. ResultsFifty two patients were included in the review. In 21 patients (40.3%), tumors were adjacent to major vessels (such as inferior vena cava, superior mesenteric vein, and the splenic vessel), tumors of 31 patients (59.7%) were away from major vessles. Two operations (3.8%) were converted to hand-assistant and 2 operations (3.8%) were converted to laparotomy due to tight adherence to major vessels. The mean value of operative time was 171.4-minute (60-520 minutes) and the mean value of length of incision was 2.8 cm (1-15 cm), the mean value of estimated blood loss was 86.4 mL (10-1 150 mL), 2 patients needed blood transfusion. The mean value of time of returning to diets was 1.5-day (1-5 days) and the mean value of length of postoperative hospital stay was 4.9-day (1-16 days). There was no major postoperative complications or death. Follow up was available for 47 patients at a median time of 62.0-month (4-120 months). Three patients with retroperitoneal liposarcomas experienced recurrence at 31, 34, and 48 months after operation, 1 patient with mucinous peripheral neurilemmoma experience recurrence at 69 months after operation, all of which underwent further resection, with others experiencing no recurrence or metastasis. Three patients died in reason of other diseases. ConclusionsLaparoscopic surgery can be performed safely in the treatment of primary retroperitoneal tumors, even when a tumor adjacent to major vascular structures.
ObjectiveTo Summarize the clinical features of retroperitoneal ganglioneuroma.MethodsA total of 18 cases of pathologically confirmed retroperitoneal ganglioneuroma, who received surgery in The Affiliated Hospital of Xuzhou Medical University from May 2013 to July 2016, were collected to reviewe the clinical features, imaging findings, pathologic characteristics, treatments, and prognosis of retroperitoneal ganglioneuroma.Results① Clinical symptoms. Of the 18 cases, 8 cases were found by physical examination, and had no symptoms; 6 cases showed abdominal pain and discomfort; 3 cases had hypertension; 1 case had bulge and discomfort in the lower abdomen. ② Imaging performance. All of the 18 cases underwent color Doppler ultrasonography, 16 cases showed clear hypoechoic mass, and hypoechoic masses showed irregular shape in 2 cases; homogeneous echo in 12 cases and inhomogeneous echo in 6 cases could be seen. Seventeen cases underwent CT scan, and homogeneous low density in 14 cases, uneven density in 3 cases, scattered calcification in 3 cases could be seen. Fifteen cases underwent CT dynamic contrast-enhanced scan, 2 cases showed no significant enhancement both in dynamic and venous phase, 8 cases showed no significant enhancement in arterial phase, 11 cases showed heterogeneous enhancement in venous phase. Three cases underwent MRI scan, T1WI images of 3 cases showed uniform low signal; T2WI images showed high signal in 1 case, T2WI images showed high signal with moderate intensity in 2 cases. ③ Surgery and prognosis. Fifteen cases underwent laparoscopic retroperitoneal tumor resection,3 cases underwent open surgery, and all the tumors were completely resected. All cases had good postoperative recovery and no significant complication occurred. All cases were followed up for 6 to 32 months with a median of 20 months, no recurrence or distant metastasis was found during follow-up period.ConclusionsRetroperitoneal ganglioneuroma has nonspecific clinical manifestation. Imaging examinations are the most effective adjuvant ways preoperatively, but patholoy is still the gold standard of final diagnosis for ganglioneuroma. Radical tumor resection is the most effective therapy with satisfactory prognosis for ganglioneuroma.
ObjectiveTo summarize the predictive factors of recurrence of retroperitoneal sarcoma.MethodsThe literatures on the recurrence of retroperitoneal sarcoma at home and abroad were reviewed and analyzed.ResultsTumor size, margin negative resection, tumor grade, multifocal, and histological types were important predictors of the recurrence of retroperitoneal sarcoma. In addition, combined organ resection, diversity of tumor growth patterns, and tumor-free surgical techniques could also affect the recurrence of retroperitoneal sarcoma.ConclusionUnderstanding the predictive factors of the recurrence of retroperitoneal sarcoma is of great significance to guide surgeons to understand and recognize the disease, to reduce the recurrence of retroperitoneal sarcoma.
ObjectiveTo understand the pathogenesis and the research progress of comprehensive treatment of primary retroperitoneal liposarcoma (PRLPS) and to provide evidence for clinical diagnosis and treatment.MethodThe recent literatures on the pathological classification, pathogenesis of PRLPS, and comprehensive treatment including the surgery, radiotherapy, chemotherapy, and molecular targeted therapy were reviewed.ResultsThe pathological types of PRLPS were highly differentiated, dedifferentiated, mucoid/round cell, polymorphic, and mixed. The main molecular pathogenesis was the synergistic effect of MDM2 with related genes, abnormal expressions of c-myc gene and microRNAs, Prune-nm23-H1 mechanism, and abnormal protein products of FUS-CHOP fusion gene which regulated the growth of tumor. The treatment of PRLRS included the radical resection, extended resection, and palliative resection combined with radiotherapy, chemotherapy, and molecular targeted therapy.ConclusionsPRLPS is a rare malignant tumor with high recurrence rate, but early diagnosis and treatment are difficult. With the further study of the molecular mechanism of PRLPS, the treatment of PRLPS has been transformed into a comprehensive treatment based on surgery, adjuvant radiotherapy and chemotherapy, and molecular targeted therapy.
ObjectiveTo summarize the experience of diagnosis and treatment of a patient with liver and lung metastasis and retroperitoneal metastasis from right colon cancer.MethodsA retrospective analysis of a patient with liver, lung, and retroperitoneal metastasis from right colon cancer who received treatment at The First Affiliated Hospital of Kunming Medical University in August 2016 was conducted. In order to provide reference for domestic doctors to treat advanced colorectal cancer.ResultsAfter receiving several cycles of chemotherapy and three surgical resections of the primary and metastatic lesions before the MDT, the patient again found a retroperitoneal mass. After discussions of Department of Imaging, Oncology, Radiotherapy, and Gastrointestinal and Hernia Surgery, we thought that, at present, the treatment of the patient was mainly surgery and oral chemotherapy. So the patient underwent retroperitoneal tumor resection+abdominal adhesion release, and had been interviewed for 3 months. No recurrence or metastasis was found during follow-up.ConclusionThe therapy of liver-lung metastasis and retroperitoneal metastasis in right colon cancer are mainly based on surgical resection of lesions, postoperative combined with radiotherapy and chemotherapy, molecular targeted therapy, and postoperative monitoring of CEA changes.
ObjectiveTo explore the application value of multidisciplinary collaborative team (MDT) model in retroperitoneal tumors involving large vessels.MethodsThree cases of retroperitoneal tumors involving great vessels admitted to Xiang’an Hospital of Xiamen University in 2019 were retrospectively analyzed. With the support of 3D visual reconstruction and virtual reality (VR) technology, we performed MDT discussion and three cases received treatment of surgery, intervention, and targeted therapy.ResultsCase 1 was discussed by MDT and concluded that, based on CT examination, 3D reconstruction, and VR virtual image results, the tumor on the right side was determined to be completely resectable. The left tumor was judged to be unresectable, and the proposed treatment plan was right metastatic tumor resection + left metastatic tumor radiofrequency ablation. After surgery case 1 had been followed up for 6 months. The symptoms of diarrhea were significantly improved. CT reexamination showed that liver lesions and left retroperitoneal lesions were the same size and the condition was stable. After discussion by MDT, radiofrequency ablation around the tumor was proposed for case 2. This case was followed up for 3 months after surgery, and CT reexamination showed no new lesion in retroperitoneum. After MDT discussion, we concluded that arteriovenous fistula of case 3 had no indications for surgery, and proposed interventional combined with targeted therapy. After treatment, the tumor was found to be smaller after reexamination in 8 months than before treatment, and the efficacy was evaluated as partial remission. The follow-up was continued.ConclusionThe future development trend of retroperitoneal tumor therapy involving great vessels is to evaluate each patient’s condition under the MDT mode by using 3D visual reconstruction and VR technology, and to formulate the individualized treatment plan of operation combined with other treatments.
Objective To investigate the application and clinical efficacy of orthotopic autologous renal transplantation combined with inferior vena cava (IVC) resection and reconstruction in retroperitoneal tumor. Methods The clinical data of a patient with complex retroperitoneal tumor was analyzed retrospectively. Abdominal CT examination showed that the tumor originated from IVC and invaded the retrohepatic IVC and bilateral renal vein trunks. Intraoperative ultrasound exploration revealed mechanized thrombosis in the IVC and bilateral renal vein trunks. After blocking the left renal vein, no significant hemodynamic changes were seen before and after intraoperative ultrasound exploration and contrast-enhanced ultrasound. Results After complete removal of the left renal vein and suture of the severed end, the right renal vein was successfully reconstructed with an orthotopic autologous right kidney graft combined with IVC resection after removal of the mechanized thrombus. The patient recovered well after surgery, and a repeat CT showed that the reconstructed artificial IVC was patent, and the color Doppler ultrasonography of both kidneys showed good perfusion and no obstruction of return. The patient was given oral rivaroxaban anticoagulant therapy after operation, and discharged at 19 days after operation. The postoperative pathological findings suggested inferior vena cava smooth muscle sarcoma. Conclusion Orthotopic autologous renal transplantation combined with IVC resection and reconstruction for complex retroperitoneal tumor is safe and feasible, and the left renal vein can be ligated and dissected intraoperatively, but a comprehensive evaluation with intraoperative ultrasound (imaging) is required.
ObjectiveTo analyze the current status and risk factors of postoperative complications in patients with retroperitoneal tumor (RPT) and to establish a nomogram for predicting the occurrence of postoperative complications. MethodsThe clinicopathologic data of patients with RPT who met the inclusion criteria in the West China Hospital of Sichuan University from June 2019 to May 2022 were retrospectively collected. The risk factors of postoperative complications were analyzed by using univariate and multivariate analyses, and the nomogram was constructed based on the risk factors and validated. ResultsA total of 205 patients were collected in this study, 70 (34.1%) of whom had postoperative complications. The multivariate analysis results of logistic regression showed that the preoperative serum albumin ＜35 g/L [OR=2.355, 95%CI (1.256, 4.416), P=0.008], tumor sarcoma [OR=2.498, 95%CI (1.219, 5.120), P=0.012], and visceral resection [OR=2.008, 95%CI (1.042, 3.868), P=0.037] increased the probability of postoperative complications for the patients with RPT. The area under the receiver operating characteristic curve of the nomogram based on the risk factors in predicting the occurrence of postoperative complications was 0.704 [95%CI (0.626, 0.781), P<0.001]. The consistency index of the nomogram by internal verification was 0.704 [95%CI (0.628, 0.779)]. The calibration curve of the nomogram showed that the predicted value was basically consistent with the actual value, the Hosmer-Lemeshow goodness-of-fit test model had a good goodness-of-fit (χ2=3.407, P=0.906). ConclusionsFrom the results of this study, the tumor sarcoma, lower preoperative serum albumin, and visceral resection are associated with postoperative complications for patients with RPT. The nomogram based on risk factors has a good predictive value for postoperative complications.