Resection of previously inoperable retroperitoneal liposarcoma

Abstract

We present a case of successful resection of a large right upper quadrant retroperitoneal dedifferentiated liposarcoma involving multiple adjacent organs, initially considered inoperable in a patient in his 40s. This case highlights the importance of extensive preoperative planning and a multidisciplinary approach in achieving a greater chance of curative resection. Preoperative optimisation included neoadjuvant chemotherapy, concurrent portal vein embolisation and hepatic vein embolisation. The patient then underwent en-bloc resection, including total pancreatectomy, hemihepatectomy and vena caval resection in conjunction with extracorporeal membrane oxygenation and percutaneous venovenous bypass.

Keywords: Cancer intervention; Interventional radiology; Oncology; Pancreas and biliary tract; Surgical oncology.

Figure 1

Initial CT scan demonstrating large right retroperitoneal tumour involving the right lobe of the liver and right kidney.

Figure 2

Staging positron emission tomography (PET) scan demonstrating high-grade activity of right retroperitoneal lesion and low-grade activity in left axillary lymph nodes.

Figure 3

Fluoroscopic image demonstrating embolisation and vascular plug of the right portal vein and right hepatic vein.

Figure 4

Restaging PET scan demonstrating stable metabolic appearances of large intensely avid right upper quadrant lesion involving right hepatic lobe, right kidney and right adrenal gland.

Figure 5

(A) Pre-embolisation Liver quantification single-photon emission computerised tomography (SPECT) scan. (B) Post-embolisation Liver quantification SPECT scan demonstrating increased liver remnant function.

Figure 6

Large retroperitoneal tumour (arrow) resected en-bloc with right hemihepatectomy (a), a segment of inferior vena cava (b), right kidney (c) and ureter, duodenum (d), pancreas (e), and right hemicolectomy (f).

Figure 7

Histopathological specimen—right retroperitoneal tumour. (A) Spindle cell mesenchymal neoplasm invading right kidney. (B) Spindle cell mesenchymal neoplasm invading right lobe of the liver.

Figure 8

CT demonstrating postoperative seroma requiring percutaneous drainage.

Figure 9

(A) Chest X-ray demonstrating right-sided chylothorax. (B) Chest X-ray demonstrating drainage of chylothorax post insertion of the intercostal catheter. (C) Chest X-ray at 6-week follow-up demonstrating resolution of right-sided chylothorax.