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

Abstract

Background: Retroperitoneal 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.

Methods: Fifty-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.

Results: In 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).

Conclusions: Complete resection of challenging retroperitoneal tumors is feasible and can be done safely with important pre- and intraoperative considerations in mind.

Figure 1

Retroperitoneal Tumor Involvement of the Inferior Vena Cava (IVC). Preoperative computed tomography scan demonstrates IVC involvement without obvious venous collateralization (a). The tumor was resected en bloc with a portion of the IVC (b) and reconstructed using synthetic polytetrafluoroethylene (PTFE) tube graft (c). Follow-up imaging was done postoperatively (d).

Figure 2

Final Pathology of Retroperitoneal Tumors. Among malignant tumors (a), sarcoma was the most common diagnosis. A variety of pathology was encountered for benign tumors (b). MPNST = malignant peripheral nerve sheath tumor.