Intra and extra pelvic multidisciplinary surgical approach of retroperitoneal sarcoma: Case series report

Heekyoung Song; Jung Hwan Ahn; Yuyeon Jung; Jae Yeon Woo; Jimin Cha; Yang-Guk Chung; Keun Ho Lee

doi:10.12998/wjcc.v10.i27.9693

Intra and extra pelvic multidisciplinary surgical approach of retroperitoneal sarcoma: Case series report

World J Clin Cases. 2022 Sep 26;10(27):9693-9702. doi: 10.12998/wjcc.v10.i27.9693.

Authors

Heekyoung Song¹, Jung Hwan Ahn², Yuyeon Jung², Jae Yeon Woo², Jimin Cha², Yang-Guk Chung³, Keun Ho Lee⁴

Affiliations

¹ Department of Obstetrics and Gynecology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea.
² Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea.
³ Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea.
⁴ Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea. hohoho@catholic.ac.kr.

Abstract

Background: Retroperitoneal sarcoma (RPS) is a rare malignancy arising from mesenchymal cells that most commonly presents as an abdominal mass and is associated with poor prognosis. Although several studies have assessed the survival benefits of wide excision, few have reported detailed methods for achieving wide excision in patients with RPS.

Aim: To describe our experience with multidisciplinary surgical resection of RPS using intra- and extra-pelvic approaches.

Methods: Multidisciplinary surgery is an anatomical approach that combines intra- and extra-peritoneal access within the same surgery to achieve complete RPS removal. This retrospective review of the records of patients who underwent multidisciplinary surgery for RPS analyzed surgical and survival outcomes.

Results: Eight patients underwent 10 intra- and extra-pelvic surgical resections, and their median mass size was 12.75 cm (range, 6-45.5 cm). Using an intrapelvic approach, laparoscopy-assisted surgery was performed in four cases and laparotomy surgery in six. Using an extrapelvic approach, ilioinguinal and posterior approaches were used in four cases each, and the prone position and midline skin incision were shared in one. All patients' RPS masses were removed completely, and four achieved R0 resection through intra- and extra-pelvic surgery. The median estimated blood loss was 2000 mL (range, 300-20000 mL) and the median hospitalization was 12.6 d (range, 9-69 d). Reoperation was needed in two patients (one for wound necrosis and the other for bowel perforation and wound necrosis). The median overall survival rate and median progression-free survival were 64.6 and 13.7 mo, respectively.

Conclusion: RPS is therapeutically challenging because of its location and high risk of recurrence. Therefore, intra- and extra-pelvic surgical approaches can improve the macroscopic security of the surgical margin.

Keywords: Margins of excision; Retroperitoneal neoplasms; Sarcoma.