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Hou Z, Xie Q, Qiu G, Jin Z, Mi S, Liu C, Huang J. Safety and efficacy of laparoscopic transperitoneal versus retroperitoneal resection for benign retroperitoneal tumors: a retrospective cohort study. Surg Endosc 2023; 37:9299-9309. [PMID: 37884734 DOI: 10.1007/s00464-023-10504-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/24/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND AND OBJECTIVE Benign retroperitoneal tumors (BRTs) are clinically rare solid tumors. This study aimed to compare the safety and efficacy of laparoscopic transperitoneal versus retroperitoneal resection for BRTs. METHODS The clinical data of 43 patients who had pathologically confirmed BRTs and underwent laparoscopic resection in a single center from January 2019 to May 2022 were retrospectively analyzed. Patients were divided into two groups according to the surgical methods: the Transperitoneal approach group (n = 24) and the Retroperitoneal approach group (n = 19). The clinical characteristics and perioperative data between the two groups were compared. The baseline data and surgical variables were analyzed to determine the impact of different surgical approaches on the treatment outcomes of BRTs. RESULTS No significant difference was observed between the two groups in gender, age, body mass index, the American Society of Anesthesiologists score, presence of underlying diseases, tumor size, tumor position, operation duration, intraoperative hemorrhage, postoperative hospital stay, intestinal function recovery time, and postoperative complication rate. The conversion rate from laparoscopic to open surgery was significantly lower in the Transperitoneal approach group than in the Retroperitoneal approach group (1/24 vs. 5/19, χ2 = 4.333, P = 0.037). Tumor size was an independent influencing factor for the effect of surgery (odds ratio = 1.869, 95% confidence interval = 1.135-3.078, P = 0.014) and had a larger efficacy on the retroperitoneal group (odds ratio = 3.740, 95% confidence interval = 1.044-13.394, P = 0.043). CONCLUSION The laparoscopic transperitoneal approach has the inherent advantages of anatomical hierarchies and surgical space, providing a better optical perspective of the targeted mass and improved bleeding control. This approach may have better efficacy than the retroperitoneal approach, especially in cases of a large tumor or when the tumor is located near important blood vessels.
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Affiliation(s)
- Ziqi Hou
- Division of Liver Surgery, Department of General Surgery and Laboratory of Liver Surgery, State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Qingyun Xie
- Division of Liver Surgery, Department of General Surgery and Laboratory of Liver Surgery, State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Guoteng Qiu
- Division of Liver Surgery, Department of General Surgery and Laboratory of Liver Surgery, State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Zhaoxing Jin
- Division of Liver Surgery, Department of General Surgery and Laboratory of Liver Surgery, State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Shizheng Mi
- Division of Liver Surgery, Department of General Surgery and Laboratory of Liver Surgery, State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan Province, China
| | - Chang Liu
- Division of Liver Surgery, Department of General Surgery and Laboratory of Liver Surgery, State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan Province, China.
| | - Jiwei Huang
- Division of Liver Surgery, Department of General Surgery and Laboratory of Liver Surgery, State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan Province, China.
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Bobadilla-Rosado LO, Lopez-Pena G, Verduzco-Vazquez AT, Laparra-Escareno H, Anaya-Ayala JE, Azcorra H, Mendez-Dominguez N, Hinojosa CA. Five-year survival after retroperitoneal oncologic resection with and without vascular surgeon intervention. Vascular 2023; 31:868-873. [PMID: 35492002 DOI: 10.1177/17085381221093855] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
OBJECTIVES Retroperitoneal tumor resection commonly disturbs major vessels; therefore, surgical teams can recruit vascular surgeons to prevent injuries and improve the prognosis of oncologic patients. The objective of the present study is to establish long-term survival after retroperitoneal tumor resection surgery with an emphasis on the potential impact of preventing or repairing major vessel injuries when tumors are adjacent to the aorta or vena cava. METHODS Retrospective case series including all cases of surgical removal of retroperitoneal tumors between 2007 and 2020 in a highly specialized hospital in Mexico City. Long-term survival was defined as 5 years after surgical intervention. Descriptive statistics, group-comparison tests, and regression analysis were performed using Stata 16. RESULTS From a total of 70 cases, vascular injury occurred in 30 (42.8%) and the vascular surgeon intervened in 19 (27.1%) of them, 4 (21%) were performed by a vascular surgeon with planned intervention, and in 9 (47.3%) cases the vascular surgeon was called to join the surgery due to emergency. Intraoperative bleeding was 2-fold greater in the group with an emergent participation of vascular surgery in contrast with the planned intervention group (4, 235 mL vs 2, 035 mL, p = 0.04). The regression model revealed a significant association between the intervention of a vascular surgeon and long-term survival (OR 59.3, p = 0.03) after adjusting for sociodemographic and characteristics of oncologic nature. CONCLUSIONS Planned intervention of vascular surgeons in retroperitoneal tumor resection may have a positive impact not only in trans-operatory period, but also on long-term survival.
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Affiliation(s)
- Luis O Bobadilla-Rosado
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Gabriel Lopez-Pena
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Ana T Verduzco-Vazquez
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Hugo Laparra-Escareno
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Javier E Anaya-Ayala
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Hugo Azcorra
- Centro de Investigaciones Silvio Zavala, Universidad Modelo de Merida, Mexico
| | - Nina Mendez-Dominguez
- Vice Direction of Research and Learning, Hospital Regional de Alta Especialidad de la Peninsula de Yucatan, Merida, Mexico
| | - Carlos A Hinojosa
- Section of Vascular Surgery and Endovascular Therapy, Department of Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
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3
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Review of diagnosis, differential diagnosis, and management of retroperitoneal lymphangioma. Jpn J Radiol 2023; 41:283-301. [PMID: 36327088 DOI: 10.1007/s11604-022-01356-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
Lymphatic malformation (LM) is the currently preferred term for what was previously known as lymphangioma. Retroperitoneal LMs are extremely rare, benign, cystic masses that arise from lymphatic vessels. They can be challenging to diagnose because they resemble other retroperitoneal cystic tumors. The development of treatment strategies for rare diseases, including retroperitoneal LM, requires the acquisition of new knowledge to enhance our understanding of the disease progression. Therefore, we present an update regarding fundamental and advanced issues associated with retroperitoneal LM. This review describes the epidemiology, histopathology, biomedicine, clinical manifestations, radiological features, differential diagnosis, and management of this lesion.
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Komarov RN, Egorov AV, Osminin SV, Bilyalov IR, Zhemerikin GA, Ryabov KY, Novikov SS. [The first experience of small intestinal autotransplantation for advanced digestive cancer]. Khirurgiia (Mosk) 2023:34-42. [PMID: 38088839 DOI: 10.17116/hirurgia202312134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Usually, gastrointestinal tumors (GIT) invading great vessels are acknowledged to be irresectable. Along with that, we can expect positive oncological results only when there is combination treatment with radical surgery (R0 resection). In this article we share the first experience of small intestinal autotransplantation as a method of radical surgery in locally advanced GIT. We conducted the analysis of outcomes of three patients (with pancreas cancer (n=2) and neuroendocrine tumor of caecum (n=1), with neoplastic process involving to superior mesenteric artery and vein. We analyzed intraoperative aspects and algorithm of small intestinal autotransplantation. Long-term outcomes with 1.5-13 months of observing time are presented. On the basis of conducted analysis the authors suggest the possibility of small intestinal autotransplantation in referral centers with strict personalized approach and multidisciplinary surgical team.
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Affiliation(s)
- R N Komarov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - A V Egorov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - S V Osminin
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - I R Bilyalov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - G A Zhemerikin
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - K Yu Ryabov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - S S Novikov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Karakida N, Yanazume S, Tokudome A, Sonoda M, Kobayashi H. Successful Treatment of a Life-Threatening Pulmonary Embolism Following Retroperitoneal Tumor Surgery. Cureus 2022; 14:e31501. [DOI: 10.7759/cureus.31501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 11/16/2022] Open
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Cochetti G, Paladini A, de Vermandois JAR, Fatigoni S, Zanelli M, Ascani S, Mearini E. Metastatic renal Ewing's sarcoma in adult woman: Case report and review of the literature. Open Med (Wars) 2021; 16:397-409. [PMID: 33748424 PMCID: PMC7957192 DOI: 10.1515/med-2021-0207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 11/22/2020] [Accepted: 12/09/2020] [Indexed: 01/18/2023] Open
Abstract
Primary renal extra-skeletal Ewing sarcoma is a rare neoplasm, often metastatic at diagnosis, and with a poor outcome. A multimodal approach is often the treatment of choice in this aggressive neoplasm. We present a case of primary renal extra-skeletal sarcoma in a 45-year-old woman who underwent tumor resection without clear margins. After no response to the first cycle of chemotherapy, we documented an early onset of local recurrence. The patient refused any other treatment and died four months after surgery.
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Affiliation(s)
- Giovanni Cochetti
- Department of Surgical and Biomedical Sciences, Urology Clinic, University of Perugia, Perugia, Italy
| | - Alessio Paladini
- Department of Surgical and Biomedical Sciences, Urology Clinic, University of Perugia, Perugia, Italy
| | | | - Sonia Fatigoni
- Department of Surgical and Biomedical Sciences, Medical Oncology, University of Perugia, Perugia, Italy
| | - Magda Zanelli
- Department of Oncology and Advanced Technologies, Pathology Unit, Arcispedale Santa Maria Nuova di Reggio Emilia, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Ascani
- Department of Experimental Medicine, Institute of Pathologic Anatomy, “Santa Maria” Hospital, Terni, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, Urology Clinic, University of Perugia, Perugia, Italy
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7
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Jeon HM, Lee JS, Kim SH, Yun KH, Park KH, Jeon MK, Lee YH, Yoon HI, Suh JS, Hur H, Kim KS, Kim S, Kim SH, Kim HS. Comprehensive Immuno-Molecular Profiles for Liposarcoma: Roles of Programmed Death Ligand 1, Microsatellite Instability, and PIK3CA. Oncology 2020; 98:817-826. [PMID: 32892196 DOI: 10.1159/000509004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/27/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Developing personalized strategies for cancer has shown good efficacies. METHODS We assessed the molecular targets programmed death ligand 1 (PD-L1), microsatellite instability (MSI), and PIK3CA. Seventy-four patients with liposarcomas who underwent curative resection were assessed for PD-L1 expression in the tumor and tumor-infiltrating lymphocytes (TILs), mismatch repair proteins (MLH1, PMS2, MSH2, and MSH6) by immunohistochemistry, MSI using polymerase chain reaction, and PIK3CA mutation/amplification using pyrosequencing and fluorescence in situ hybridization. RESULTS Seventeen (23%) cases were TIL+ (≥1 + expression) and associated with longer 5-year overall survival than those with TIL- tumors (84.4 vs. 60.8%, p = 0.007). Six (35.3%) PD-L1+ tumors were detected only in TIL+ cases, with none detected in tumor cells. Two well-differentiated liposarcomas showed MSI, one low and one high with concurrent loss of MLH1, MSH6, and PMS2. PIK3CA mutation was detected in 7 (9.5%) [exon 9 (n = 4) and exon 20 (n = 3)] and only 1 Q546K mutation was a PD-L1+ tumor. PIK3CA copy number gain was detected in 18 (24.4%) and was associated with TIL+ tumors (p = 0.045). CONCLUSIONS Our comprehensive immuno-molecular panel suggests that liposarcoma should be categorized based on the molecular genomic subtype for precision medicine.
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Affiliation(s)
- Hyae Min Jeon
- Pathology Center, Seegene Medical Foundation, Seoul, Republic of Korea
| | - Jae Seok Lee
- Department of Pathology, Sungkyunkwan University School of Medicine, Samsung Changwon Hospital, Changwon, Republic of Korea
| | - Soo Hee Kim
- Pathology Center, Seegene Medical Foundation, Seoul, Republic of Korea
| | - Kum-Hee Yun
- Yonsei Song-Dang Institute for Cancer Research, Yonsei University Health System, Seoul, Republic of Korea.,Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyu Hyun Park
- Yonsei Song-Dang Institute for Cancer Research, Yonsei University Health System, Seoul, Republic of Korea
| | - Min Kyung Jeon
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Han Lee
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin-Suck Suh
- Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyuk Hur
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Sik Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sunghoon Kim
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Hyun Kim
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo Song Kim
- Yonsei Song-Dang Institute for Cancer Research, Yonsei University Health System, Seoul, Republic of Korea, .,Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea,
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8
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Montero A, Nuñez M, Hernando O, Vicente E, Ciervide R, Zucca D, Sanchez E, López M, Quijano Y, Garcia-Aranda M, Alonso R, Valero J, Chen X, Alvarez B, Fernandez-Leton P, Rubio C. Retroperitoneal soft-tissue sarcomas: Radiotherapy experience from a tertiary cancer center and review of current evidence. Rep Pract Oncol Radiother 2020; 25:643-655. [PMID: 32565743 PMCID: PMC7292898 DOI: 10.1016/j.rpor.2020.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/14/2020] [Accepted: 05/25/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Surgery remains to be the main therapeutic approach for retroperitoneal sarcomas (RPS) although evidence supports that complementary radiotherapy increases local-control and survival. We present a multidisciplinary management and experience of a tertiary cancer center in the treatment of RPS and analyze current evidence of radiotherapy efficacy. PATIENTS AND METHODS We retrospectively reviewed 19 patients with primary or relapsed RPS treated between November 2009 and October 2018. Multidisciplinary approach comprised complete resection in 15 patients (79%) achieving resection R0 in 11 patients (58%), R1 in 4 patients (21%) and R2 in 2 patients (10%). Seven patients (37%) underwent a preoperative radiation (PRORT), 10 patients (53%), post-operative radiation (PORT) and 2 patients (10%), received radiotherapy exclusively. Ten patients (53%) received adjuvant chemotherapy. RESULTS With a median follow-up of 24 months (2-114 months), actuarial rates of loco-regional relapse free survival (LRFS) at 1, 2 and 3 years were 77%, 77% and 67%, respectively. Actuarial rates of distant-metastases-free survival (DMFS), disease-free survival (DFS) and overall survival (OS) at 1, 2 and 3 years were 100%, 100% and 80% for DMFS; 94%, 77% and 67% for DFS and 100%, 91% and 91% for OS, respectively. Only surgical margins (negative vs. positive) showed significance for 3y-LRFS: 100% vs. 34.3%, p = 0.018. Treatment tolerance was acceptable with no acute or late toxicity higher than grade 2. CONCLUSIONS Complementary radiotherapy appears to be useful and well tolerated for the multidisciplinary management of RPS. Presence of positive surgical margins seems to be the most relevant prognostic factor through the follow-up.
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Affiliation(s)
- A. Montero
- Department of Radiation Oncology, University Hospital HM Sanchinarro, Madrid, Spain
| | - M. Nuñez
- Department of Radiation Oncology, University Hospital HM Sanchinarro, Madrid, Spain
| | - O. Hernando
- Department of Radiation Oncology, University Hospital HM Sanchinarro, Madrid, Spain
| | - E. Vicente
- Department of General Surgery, University Hospital HM Sanchinarro, Madrid, Spain
| | - R. Ciervide
- Department of Radiation Oncology, University Hospital HM Sanchinarro, Madrid, Spain
| | - D. Zucca
- Department of Medical Physics, University Hospital HM Sanchinarro, Madrid, Spain
| | - E. Sanchez
- Department of Radiation Oncology, University Hospital HM Sanchinarro, Madrid, Spain
| | - M. López
- Department of Radiation Oncology, University Hospital HM Sanchinarro, Madrid, Spain
| | - Y. Quijano
- Department of General Surgery, University Hospital HM Sanchinarro, Madrid, Spain
| | - M. Garcia-Aranda
- Department of Radiation Oncology, University Hospital HM Sanchinarro, Madrid, Spain
| | - R. Alonso
- Department of Radiation Oncology, University Hospital HM Sanchinarro, Madrid, Spain
| | - J. Valero
- Department of Radiation Oncology, University Hospital HM Sanchinarro, Madrid, Spain
| | - X. Chen
- Department of Radiation Oncology, University Hospital HM Sanchinarro, Madrid, Spain
| | - B. Alvarez
- Department of Radiation Oncology, University Hospital HM Sanchinarro, Madrid, Spain
| | - P. Fernandez-Leton
- Department of Medical Physics, University Hospital HM Sanchinarro, Madrid, Spain
| | - C. Rubio
- Department of Radiation Oncology, University Hospital HM Sanchinarro, Madrid, Spain
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Abstract
Discovery of an adrenal mass is nowadays a frequent situation. While adrenal tumors can cause a variety of symptoms, more often than not they are diagnosed incidentally on imaging exams such as CT-scan or MRI performed for another purpose. However, any retroperitoneal supra-renal mass can have an extra-adrenal origin. Indeed, operated non-adrenal masses initially but wrongly diagnosed as an adrenal disease represent about 3.5% of adrenalectomies. These differential diagnoses principally include retroperitoneal tumors that are malignant in two thirds of cases (lymphomas, sarcomas, neurogenic or germinal tumors), and more rarely vascular anomalies or congenital malformations, which are most frequently left-sided due to the wide variety of anatomical structures surrounding the left adrenal gland. Several lesions can originate from the adrenal gland or be located near the gland (paraganglioma, ganglioneuroma). Even though unilateral adrenalectomy is associated with low morbidity, ignorance of these differential diagnoses can cause ill-adapted management; overly conservative surgery in case of sarcoma is one example. Some of these lesions have characteristic clinical or imaging features (cystic lymphangioma, angiomyolipoma…). In other cases, assessment of hormonal secretion is required and additional exams (MRI, percutaneous biopsy, PET-scan with 18-Fluorodeoxyglucose) can correct an erroneous diagnosis. The above diagnostic approach allows appropriate management (with or without surgery). The purpose of this review was to highlight the main differential diagnoses of adrenal masses, to describe their characteristics, and to discuss their therapeutic management.
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10
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Ye S, Wang P, Zhu L, Jing T, Qin J, Zhu Y, Xia D, Wang S. Robot-Assisted Laparoscopic Excision of Complicated Retroperitoneal Tumors with Four Arms Via Retroperitoneal Way: A Unique Minimal-Invasive Approach. J Laparoendosc Adv Surg Tech A 2020; 30:1110-1116. [PMID: 31916899 DOI: 10.1089/lap.2019.0532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Surgical management of complicated retroperitoneal mass is one of the most challenging urologic oncologic surgeries. This study aims to describe our technique and experience in dealing with retroperitoneal mass. Methods: Three patients with complicated retroperitoneal mass were treated with robot-assisted surgery with four arms through retroperitoneal approach. Surgical Procedure: Our standardized anatomic-based "kidney safe first, then mass resection" technique for robot-assisted complicated retroperitoneal mass resection focused on minimizing the chance of renal pedicle injury. Baseline demographics, pathology data, and latest follow-up outcome were obtained. Results: In this retrospectively reviewed case series, all 3 patients were successfully treated with robot-assisted surgery with four arms during retroperitoneal space. One patient received paravertebral mass resection 2 weeks after the robotic surgery. Mean data included operative time of 175 minutes, estimated blood loss was 133 mL, and hospital stay was 4 days. No complications occurred. Conclusions: Robot-assist surgery for complicated retroperitoneal mass with four arms is a safe and feasible way. Patient Summary: Mini-invasive treatment for retroperitoneal mass with robotic four arms through retroperitoneal approach is a feasible way. The approach reduces interruption of intracorporeal structure and organs. And patients could benefit from the retroperitoneal approach with a quicker recovery.
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Affiliation(s)
- Sunyi Ye
- Department of Urology and The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ping Wang
- Department of Urology and The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lixian Zhu
- Department of Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Taile Jing
- Department of Urology and The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jie Qin
- Department of Urology and The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yi Zhu
- Department of Urology and The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Dan Xia
- Department of Urology and The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shuo Wang
- Department of Urology and The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Cuen-Ojeda C, Rivera-Banuelos JH, Anaya-Ayala JE, Hinojosa CA. Retroperitoneal Germ Cell Tumor Resection with Primary Inferior Vena Cava Reconstruction. Ann Vasc Dis 2019; 12:243-245. [PMID: 31275484 PMCID: PMC6600093 DOI: 10.3400/avd.cr.18-00159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Retroperitoneal tumors (RTs) are frequently found as large masses upon diagnosis. Within the differential diagnosis of RTs, one of the most important are germ cell tumors. We report here the case of a 30 year old man with a recurrent RT involving the inferior vena cava (IVC). Once discussed, he underwent a tumor resection with a primary IVC reconstruction maintaining vessel patency. On histopathology, a mixed germ cell tumor was reported. The patient recovered well and he was discharged from the hospital without complications.
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Affiliation(s)
- Cesar Cuen-Ojeda
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Jesus H Rivera-Banuelos
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Javier E Anaya-Ayala
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Carlos A Hinojosa
- Department of Surgery, Section of Vascular Surgery and Endovascular Therapy, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
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12
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The diagnostic utility of retroperitoneoscopic tissue biopsy for unresectable retroperitoneal lesions excluding urogenital cancers. World J Surg Oncol 2019; 17:35. [PMID: 30777073 PMCID: PMC6379945 DOI: 10.1186/s12957-019-1581-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background Retroperitoneal tumors are an uncommon disease known to consist of a diverse group of benign and malignant neoplasms. Treatment of unresectable retroperitoneal lesions requires pathological diagnosis. Here, we report the utility and safety of retroperitoneoscopic biopsy for unresectable retroperitoneal lesions excluding urogenital cancers. Methods We analyzed 47 patients consisting of 23 (49%) and 24 (51%) cases that underwent retroperitoneoscopic tissue biopsy and open biopsy, respectively. The clinicopathological features, including postoperative complications, were compared between the two groups. Results Tumor pathology was diagnosed successfully with a single operation in all patients. Malignant pathology (68%) was more common than benign pathology (32%). The most common pathology was malignant lymphoma, which accounted for about 50% of all cases. There was no significant difference with respect to the age, sex, tumor size, presence of tumor-related symptom, histopathology, operative time, and complications. Three (13%) of 23 patients in the retroperitoneoscopic biopsy group received percutaneous needle biopsy before laparoscopic excisional biopsy because the evaluation of needle cores failed to confirm subclasses of diagnosed pathologies. One patient was converted to open surgery just after the initiation of operation due to severe adhesion of adjacent structures. We had two cases with iatrogenic urinoma due to ureteral injury after retroperitoneoscopic biopsy. Conclusions We conclude that retroperitoneoscopic biopsy is a safe and useful tool for benign and malignant retroperitoneal lesions, in comparison to open biopsy. It is critical to carefully examine the preoperative imaging for the location of tumors, especially those close to the renal pelvis and ureter.
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13
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Füllhase C, Harke N, Niedworok C, Protzel C, Hakenberg OW. Retroperitoneal Tumors in Adults. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Abstract
Primary retroperitoneal masses constitute a heterogeneous group of uncommon
lesions and represent a challenge due to overlapping imaging findings. Most are
malignant lesions. Although they are more prevalent in adults, they can occur at
any age. Such lesions are classified as primary when they do not originate from
a specific retroperitoneal organ and are divided, according to the image
findings, into two major groups: solid and cystic. The clinical findings are
nonspecific and vary depending on the location of the lesion in relation to
adjacent structures, as well as on its behavior. The main imaging methods used
for staging and surgical planning, as well as for selecting the biopsy site and
guiding the biopsy procedure, are computed tomography and magnetic resonance
imaging. In most cases, the treatment is challenging, because of the size of the
lesions, vascular involvement, or involvement of adjacent organs. In this
article, we present a review of the retroperitoneal anatomy and a practical
approach to the main imaging features to be evaluated, with a view to the
differential diagnosis, which can guide the clinical management.
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Affiliation(s)
- Micaela Maciel Dos Santos Mota
- Serviço de Radiologia do Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP, Brazil
| | - Regis Otaviano França Bezerra
- Serviço de Radiologia do Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP, Brazil
| | - Marcio Ricardo Taveira Garcia
- Serviço de Radiologia do Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP, Brazil
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15
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Aggressive Surgical Approach for Treatment of Primary and Recurrent Retroperitoneal Soft Tissue Sarcoma. Indian J Surg 2018; 80:154-162. [PMID: 29915482 DOI: 10.1007/s12262-018-1722-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 01/15/2018] [Indexed: 01/14/2023] Open
Abstract
To analyze treatment and survival in a series of resected patients with primary or recurrent retroperitoneal sarcoma (RPS) treated and prospectively followed at a single institution. Between July 1994 and December 2015, 89 patients (36 M, 53 F; mean age 60 years, range 25-79) were evaluated. For the purpose of analysis, complete resection was defined as removal of gross tumor with histologically confirmed clear resection margins. Eighty-three out of the 89 patients (93%), 46 of whom affected by primary RPS, and 37 by recurrent RPS, underwent surgical exploration. Sixty-two had a grossly and microscopically complete resection. Fifty-three out of 83 patients (64%) underwent removal of contiguous intra-abdominal organs. Preoperative mortality was nil and significant preoperative complications occurred in six cases only (7%). High-grade tumor pointed out to be a significant variable for a worse survival in all 83 patients amenable to undergo surgical resection (57% 5 years survival for low grade vs 14% for high grade; P = 0.0004). Among completely resected patients, only histologic grade clearly affected disease-free survival (72% 5 years survival for low grade vs 50% for high grade; P = 0.04), while the role of preoperative blood transfusions (67% 5 years survival for non-transfused patients vs 29% for transfused patients; P = 0.05) has to be evaluated in connection to patient complexity. Histological grade and recurrence are the most valuable prognostic predictors; in this clinical subset, an aggressive surgical approach in both primary and recurrent RPS is associated with a best long-term survival and disease-free survival.
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16
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Ziwei X, Yueming S. Recurrent Adult Intraabdominal Undifferentiated High-Grade Pleomorphic Sarcoma Infiltrated the Descending Colon: a Case Report and Review of the Literature. J Gastrointest Cancer 2018; 50:629-633. [PMID: 29577178 DOI: 10.1007/s12029-018-0071-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
MESH Headings
- Adult
- Colectomy
- Colon, Descending/diagnostic imaging
- Colon, Descending/pathology
- Colon, Descending/surgery
- Colonoscopy
- Histiocytoma, Malignant Fibrous/diagnosis
- Histiocytoma, Malignant Fibrous/pathology
- Histiocytoma, Malignant Fibrous/surgery
- Humans
- Male
- Neoplasm Invasiveness/pathology
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/surgery
- Retroperitoneal Neoplasms/diagnosis
- Retroperitoneal Neoplasms/pathology
- Retroperitoneal Neoplasms/surgery
- Retroperitoneal Space/diagnostic imaging
- Retroperitoneal Space/pathology
- Retroperitoneal Space/surgery
- Time Factors
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- Xu Ziwei
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Sun Yueming
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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17
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Resorlu M, Karatag O, Uysal F, Ozturk M. Malignant fibrous histiocytoma in a patient presenting with urinary system symptoms. Rev Assoc Med Bras (1992) 2018; 63:950-952. [PMID: 29451657 DOI: 10.1590/1806-9282.63.11.950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 05/07/2017] [Indexed: 11/21/2022] Open
Abstract
Malignant fibrous histiocytoma is a rare tumor. It is most commonly seen in individuals between the fifth and seventh decades of life, in extremities, and less frequently in the retroperitoneum. Although its etiology is not clearly known, radiotherapy, chemical agents, previous history of surgery, trauma and fracture, and Hodgkin lymphoma have been blamed. Leiomyosarcoma, liposarcoma and rhabdomyosarcoma should be taken into account in differential diagnosis. It is seen on computed tomography as a mass lesion with irregular borders and density similar to that of the surrounding muscle tissue. Necrotic and hemorrhagic components in the mass are characterized as heterogeneous low density areas. Fluid-fluid levels can be detected by computed tomography and magnetic resonance imaging.
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Affiliation(s)
- Mustafa Resorlu
- Canakkale Onsekiz Mart University, Faculty of Medicine, Radiology, Canakkale, Turkey
| | - Ozan Karatag
- Canakkale Onsekiz Mart University, Faculty of Medicine, Radiology, Canakkale, Turkey
| | - Fatma Uysal
- Canakkale Onsekiz Mart University, Faculty of Medicine, Radiology, Canakkale, Turkey
| | - Muhsin Ozturk
- Canakkale Onsekiz Mart University, Faculty of Medicine, Radiology, Canakkale, Turkey
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18
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Retroperitoneal Tumors in Adults. Urol Oncol 2018. [DOI: 10.1007/978-3-319-42603-7_42-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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19
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Abstract
Most abdominal neoplasms involving the root of the superior mesenteric artery and/or celiac artery are difficult to manage with conventional operative techniques because of limited intestinal ischemia times and poor accessibility to the tumor region. Ex vivo surgery followed by intestinal autotransplantation (IATx) is a relatively novel surgical strategy to offer chances for complete resection in such hopeless circumstances. This review aims to assess potential surgical indications, operative techniques and clinical outcomes after IATx. Currently the main indications reported for IATx broadly include pancreatic, mesenteric and retroperitoneal neoplasms closely involving the superior mesenteric vessels. The preliminary results show that radical resection can be effectively achieved in carefully selective patients. Although perioperative morbidity and mortality are relatively high, there are several long-term survivors, particularly after complete resection of benign and low-grade tumor. Early tumor recurrence, however, remains a major problem in patients with high-grade tumor, particularly pancreatic ductal carcinoma. In conclusion, IATx allows patients with selected abdominal neoplasms involving the major mesenteric vessels to be completely resected. However, this aggressive approach is associated with a considerable operative risk, and should only be performed at experienced centers. Additional and adjunctive treatment therapies are required to improve the efficacy of this treatment.
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Affiliation(s)
- Guosheng Wu
- Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi'an, Shaanxi, China
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20
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Tsiao S, Aydin N, Misra S. Neuropraxia following resection of a retroperitoneal liposarcoma. Int J Surg Case Rep 2017; 36:170-174. [PMID: 28601782 PMCID: PMC5470439 DOI: 10.1016/j.ijscr.2017.05.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 05/26/2017] [Accepted: 05/27/2017] [Indexed: 01/22/2023] Open
Abstract
Neuropraxia after resection of retroperitoneal masses can be a challenging postoperative problem. Intraoperative findings and postoperative suspicion have utmost importance in establishing differential diagnosis. Postoperative work up including neurological evaluation, MRI, and EMG help in diagnosing the condition. Aggressive postoperative physical therapy and steroids are very helpful in resolution of the condition.
Background This is a unique case of neuropraxia of femoral nerve seen after resection of retroperitoneal liposarcoma which has not been reported before in the literature. Introduction Neuropraxia, a transient paralysis due to blockage of nerve conduction, commonly associated with athletes and orthopedic procedures, has not been previously reported as a complication following resection of retroperitoneal sarcoma. Case This is an 81-year-old female who, on CT for evaluation of her atherosclerosis, was found to have an incidental right-sided retroperitoneal mass extending from the right renal capsule inferiorly through the inguinal canal. At this point, the patient reported mild right sided abdominal pain and right lower back pain, but reported no neuromotor deficits of the right lower extremity. Given the symptoms of the patient as well as the size, location and the density of the lesion, surgical intervention was pursued. On exploration, the lipomatous lesion, suggestive of liposarcoma, was invading the right genitofemoral nerve and ilioinguinal nerve which were sacrificed to ensure a complete oncologic resection. Following complete removal of the mass, she developed right side femoral nerve neuropraxia, suffering complete loss of motor function in the femoral distribution. Pathology revealed the mass to be a low grade liposarcoma. Discussion The patient required only physical therapy and oral prednisone following surgery for treatment of the neuropraxia. She responded well and has regained significant neuromotor function of the affected limb. Cases presenting with post-resection neurological sequelae without any known intraoperative nerve injury may respond very well to conservative treatment. Hence, it is very important to collaborate with Neurology and Physical Therapy to achieve best possible outcome.
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Affiliation(s)
- Stevenson Tsiao
- Texas Tech University Health Sciences Center, Department of Surgery, 1400 S. Coulter Street, Amarillo, TX 79106, United States.
| | - Nail Aydin
- Texas Tech University Health Sciences Center, Department of Surgery, 1400 S. Coulter Street, Amarillo, TX 79106, United States.
| | - Subhasis Misra
- Texas Tech University Health Sciences Center, Department of Surgery, 1400 S. Coulter Street, Amarillo, TX 79106, United States.
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21
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Fiaschetti V, Castellani F, Croce G, Mondillo M, Amico A, De Majo A, Girardi V, Di Trapano R, Floris R. Incidentally discovered well-differentiated retroperitoneal liposarcoma with inguinal canal herniation: report of 2 cases. Radiol Case Rep 2017; 12:308-312. [PMID: 28491177 PMCID: PMC5417762 DOI: 10.1016/j.radcr.2017.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 02/16/2017] [Accepted: 03/11/2017] [Indexed: 02/07/2023] Open
Abstract
Well-differentiated retroperitoneal liposarcomas are slow growing and low-grade tumors, reaching usually huge size before being symptomatic and so diagnosed, therefore with increase of the surgical risk and of the probability of dedifferentiation. Inguinal location of these tumors is unusual and rarely diagnosed.
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Affiliation(s)
- Valeria Fiaschetti
- Department of Radiology, Tor Vergata Polyclinic, Viale Oxford 81, 00100 Rome, Italy
| | - Francesca Castellani
- Department of Radiology, Tor Vergata Polyclinic, Viale Oxford 81, 00100 Rome, Italy
| | - Giusy Croce
- Department of Radiology, Tor Vergata Polyclinic, Viale Oxford 81, 00100 Rome, Italy
| | - Mariateresa Mondillo
- Department of Radiology, Tor Vergata Polyclinic, Viale Oxford 81, 00100 Rome, Italy
| | - Andrea Amico
- Department of Radiology, Tor Vergata Polyclinic, Viale Oxford 81, 00100 Rome, Italy
| | - Adriano De Majo
- Department of General Surgery, Tor Vergata Polyclinic, Rome, Italy
| | - Valentina Girardi
- Department of Radiology, Tor Vergata Polyclinic, Viale Oxford 81, 00100 Rome, Italy
| | - Roberta Di Trapano
- Department of Radiology, Tor Vergata Polyclinic, Viale Oxford 81, 00100 Rome, Italy
| | - Roberto Floris
- Department of Radiology, Tor Vergata Polyclinic, Viale Oxford 81, 00100 Rome, Italy
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22
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Yang J, Zhao Y, Zheng CH, Wang Q, Pang XY, Wang T, Ma JJ. Huge retroperitoneal liposarcoma with renal involvement requires nephrectomy: A case report and literature review. Mol Clin Oncol 2016; 5:607-609. [PMID: 27900096 DOI: 10.3892/mco.2016.1017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/10/2016] [Indexed: 11/06/2022] Open
Abstract
A 60-year-old female visited Guihang Guiyang Hospital (Guiyang, China). She presented with abdominal pain in the right side for the previous 2-months, with a touchable mass identified for the previous 1-month. Computed tomography with magnetic resonance imaging revealed a huge mass in the right abdomen. The diagnosis of well-differentiated retroperitoneal liposarcoma with renal involvement was made. During surgery, the tumor was removed, including the fatty renal capsule; however, the kidney was preserved. It is currently debatable whether resection of adjacent organs is required to obtain the negative margins. Conventional viewpoints advise that multi-organ resection is required in order to obtain the negative-margin. However, even if an R0 resection is achieved, the local recurrence rate remains markedly high. Additionally, the complications of organ resection have more impact on patients. Radiotherapy and chemotherapy are an important adjuvant method for these patients. In conclusion, retroperitoneal liposarcoma is a rare disease with a high rate of recurrence. Complete resection is the predominant treatment; however, combined resection of adjacent organs must be considered.
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Affiliation(s)
- Jun Yang
- Department of General Surgery, Guihang Guiyang Hospital, Guiyang, Guizhou 550009, P.R. China
| | - Yue Zhao
- Department of General Surgery, Guihang Guiyang Hospital, Guiyang, Guizhou 550009, P.R. China
| | - Chun Hua Zheng
- Department of General Surgery, Guihang Guiyang Hospital, Guiyang, Guizhou 550009, P.R. China
| | - Qian Wang
- Department of General Surgery, Guihang Guiyang Hospital, Guiyang, Guizhou 550009, P.R. China
| | - Xue Yu Pang
- Department of General Surgery, Guihang Guiyang Hospital, Guiyang, Guizhou 550009, P.R. China
| | - Tian Wang
- Department of General Surgery, Guihang Guiyang Hospital, Guiyang, Guizhou 550009, P.R. China
| | - Jiao Jiao Ma
- Department of General Surgery, Guihang Guiyang Hospital, Guiyang, Guizhou 550009, P.R. China
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23
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Oh YJ, Yi SY, Kim KH, Cho YJ, Beum SH, Lee YH, Suh JS, Hur H, Kim KS, Kim SH, Choi YD, Shin KH, Jun HJ, Kim SJ, Lee J, Park SH, Noh SH, Rha SY, Kim HS. Prognostic Model to Predict Survival Outcome for Curatively Resected Liposarcoma: A Multi-Institutional Experience. J Cancer 2016; 7:1174-80. [PMID: 27326262 PMCID: PMC4911886 DOI: 10.7150/jca.15243] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 04/26/2016] [Indexed: 11/20/2022] Open
Abstract
Purpose: We performed this study to analyze the clinical features and prognosis of Korean patients with liposarcoma. Patients & Methods: Between October 1986 and April 2013, 231 patients who were diagnosed with liposarcoma by histologic examination were enrolled in this study. Results: The distribution of histologic subtypes was well-differentiated (n = 97, 42%), myxoid (n = 74, 32%), dedifferentiated (n = 32, 13.9%), pleomorphic (n = 15, 6.5%), and round-cell liposarcoma (n = 13, 5.6%). The majority of liposarcomas were located in the lower extremities (35.5%) and retroperitoneum (34.2%). Prognosis was worse for the trunk group compared with the extremity group (median disease-free survival [DFS] 3.3 vs. 9.9 years, respectively, P <0.001). Median DFS was significantly worse in patients with high grade histology compared to those with low grade histology (16.9% vs. 65.7%, P <0.001). The independent prognostic factors associated with survival were histology (hazard ratio [HR] 3.01; 95% confidence interval [CI], 1.82-4.97; P <0.001) and primary site (HR 1.80; 95% CI, 1.12-2.89; P = 0.015). Three risk groups with different survival outcomes were identified: group 1 (n = 98), no risk factors; group 2 (n = 92), one risk factor; and group 3 (n = 41), two risk factors. Conclusions: Histologic subtype and primary site were independent prognostic factors for curatively resected liposarcoma. A prognostic model for patients with liposarcoma clarified distinct groups of patients with good prognostic discrimination.
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Affiliation(s)
- Yoon Jung Oh
- 1. Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Yoon Yi
- 2. Division of Hematology-Oncology, Department of Internal Medicine, Inje University Ilsan Paik Hospital; Ilsan, Korea
| | - Ki Hyang Kim
- 3. Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yong Jin Cho
- 4. Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hoon Beum
- 5. Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young Han Lee
- 6. Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Jin-Suck Suh
- 6. Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuk Hur
- 7. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Sik Kim
- 7. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hoon Kim
- 8. Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- 9. Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoo-Ho Shin
- 4. Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Jung Jun
- 10. Division of Medical Oncology & Hematology, Department of Internal Medicine, Seoul Medical Center, Seoul, Korea
| | - Sung Joo Kim
- 11. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeeyun Lee
- 12. Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Hoon Park
- 12. Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Hoon Noh
- 7. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Young Rha
- 5. Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Song Kim
- 5. Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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