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Kassi ABF, Yenon KS, Kassi FMH, Adjeme AJ, Diarra KM, Bombet-Kouame C, Kouassi M. Giant dedifferentiated liposarcoma of the gastrocolic ligament: A case report. World J Gastrointest Surg 2023; 15:2376-2381. [PMID: 37969706 PMCID: PMC10642459 DOI: 10.4240/wjgs.v15.i10.2376] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/17/2023] [Accepted: 08/23/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Dedifferentiated liposarcoma (DDLS) has a worse prognosis and occurs most commonly in the retroperitoneal region and rarely in the intraperitoneal region. Histological diagnosis was revolutionized by the combined contributions of histo-immuno-chemistry and molecular biology. Aside from surgery, there is no consensus on the optimal treatment for this chemoresistant cancer. CASE SUMMARY A thirty-year-old black female presented with a large painful abdominal mass occupying nearly the entire abdomen and progressive weight loss was admitted for surgery. Abdominal computed tomography showed a large heterogeneous mass of the mesentery that was sized 18 cm × 16 cm in size and had heterogeneous contrast enhancement. During laparotomy, en bloc excision of the large and multilobulated gastrocolic ligament mass was performed. The initial postoperative histopathological diagnosis was undifferentiated sarcoma. Finally, the results of immunohistochemistry and molecular biology allowed us to confirm the diagnosis of DDLS. The tumour followed an aggressive evolution with diffuse metastasis, causing the death of the patient less than 5 mo after the operation. CONCLUSION Dedifferentiated liposarcomas are rare tumours that typically originate in the retroperitoneum but may arise in unexpected locations.
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Affiliation(s)
- Assamoi Brou Fulgence Kassi
- Surgery and Surgical Specialities, Medical Sciences Training and Research Unit, Abidjan Felix Houphouet-Boigny University, Abidjan 01 BP V 34, Cote d'Ivoire
- Surgery and Surgical Specialities, Digestive Surgery Unit, University Hospital of Cocody, Abidjan 01 BP V13, Cote d'Ivoire
| | - Kacou Sebastien Yenon
- Surgery and Surgical Specialities, Medical Sciences Training and Research Unit, Abidjan Felix Houphouet-Boigny University, Abidjan 01 BP V 34, Cote d'Ivoire
- Surgery and Surgical Specialities, Digestive Surgery Unit, University Hospital of Cocody, Abidjan 01 BP V13, Cote d'Ivoire
| | - Fian Marc Herve Kassi
- Surgery and Surgical Specialities, Digestive Surgery Unit, University Hospital of Cocody, Abidjan 01 BP V13, Cote d'Ivoire
| | - Adja Jacob Adjeme
- Surgery and Surgical Specialities, Digestive Surgery Unit, University Hospital of Cocody, Abidjan 01 BP V13, Cote d'Ivoire
| | - Khader Morel Diarra
- Surgery and Surgical Specialities, Digestive Surgery Unit, University Hospital of Cocody, Abidjan 01 BP V13, Cote d'Ivoire
| | - Cynthia Bombet-Kouame
- Surgery and Surgical Specialities, Digestive Surgery Unit, University Hospital of Cocody, Abidjan 01 BP V13, Cote d'Ivoire
| | - Marcellin Kouassi
- Surgery and Surgical Specialities, Digestive Surgery Unit, University Hospital of Cocody, Abidjan 01 BP V13, Cote d'Ivoire
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Pegoraro F, Santangelo D, Santangelo A, Pelosio L, Jamshidi A, Camera L, Imbriaco M, Mainolfi CG, Insabato L, Accarino R, Giuliano M, Carlomagno N, D'Alessandro V, Santangelo ML. R0 surgical resection of giant dedifferentiated retroperitoneal liposarcomas in the COVID era with and without nephrectomy: A case report. Oncol Lett 2023; 26:410. [PMID: 37600332 PMCID: PMC10436160 DOI: 10.3892/ol.2023.13996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/13/2023] [Indexed: 08/22/2023] Open
Abstract
Retroperitoneal sarcomas (RPSs) are rare findings that can grow into large masses without eliciting severe symptoms. At present, surgical resection is the only radical therapy, whenever it can be performed with the aim to achieve a complete removal of the tumor. The present report describes two consecutive cases of RPSs that resulted in dedifferentiated liposarcomas (DDLPSs) and these patients underwent R0 surgical resection with and without a nephron-sparing procedure. The diagnostic workup, the surgical approach, the impact of late surgical management due to the COVID pandemic and the latest literature on the topic are discussed and analyzed. The patients, who refused to undergo any medical examination during the prior 2 years due to the COVID pandemic, were admitted to Federico II University Hospital (Naples, Italy) complaining about weight loss and general abdominal discomfort. In the first case, a primitive giant abdominal right neoplasm of retroperitoneal origin enveloping and medializing the right kidney was observed. The second patient had a similar primitive retroperitoneal giant left neoplasm, which did not affect the kidney. Given the characteristics of the masses and the absence of distant metastases, after a multidisciplinary discussion, radical surgical removal was carried out for both patients. The lesions appeared well-defined from the surrounding tissues, and markedly compressed all the adjacent organs, without signs of infiltration. In the first patient, the right kidney was surrounded and undetachable from the tumor and it was removed en bloc with the mass. The second patient benefited from a nephron-sparing resection, due to the existence of a clear cleavage plane. The postoperative courses were uneventful. Both the histological examinations were oriented towards a DDLPS and both patients benefited from adjuvant chemotherapy. In conclusion, the treatment of giant RPS is still challenging and requires multidisciplinary treatment as well as, when possible, radical surgical removal. The lack of tissue infiltration and the avoidance of excision or reconstruction of major organs (including the kidney) could lead to an easier postoperative course and an improved prognosis. When possible, surgical management of recurrences or incompletely resected masses must be pursued. Since the COVID pandemic caused limited medicalization of a number of population groups and delayed diagnosis of other oncologic diseases, an increased number of DDLPSs could be expected in the near future.
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Affiliation(s)
- Francesca Pegoraro
- Operative Unit of Hepato-Biliary-Pancreatic, Minimally Invasive and Robotic Surgery and Kidney Transplantation, Department of Clinical Medicine and Surgery, Federico II University Hospital, I-80131 Naples, Italy
| | - Domenico Santangelo
- Department of Radiology, ‘Scientific Hospitalization and Treatment Institute’ San Raffaele Hospital, I-20132 Milano, Italy
| | - Alfonso Santangelo
- Department of General Surgery and Emergency Surgery, ‘Scientific Hospitalization and Treatment Institute’ San Raffaele Hospital, I-20132 Milano, Italy
| | - Luigi Pelosio
- Operative Unit of General Surgery and Retroperitoneal Diseases, Department of Clinical Medicine and Surgery, Federico II University Hospital, I-80131 Naples, Italy
| | - Akbar Jamshidi
- Operative Unit of General Surgery and Retroperitoneal Diseases, Department of Clinical Medicine and Surgery, Federico II University Hospital, I-80131 Naples, Italy
| | - Luigi Camera
- Operative Unit of Diagnostic Imaging and Radiotherapy, Federico II University Hospital, I-80131 Naples, Italy
| | - Massimo Imbriaco
- Operative Unit of Diagnostic Imaging and Radiotherapy, Federico II University Hospital, I-80131 Naples, Italy
| | - Ciro Gabriele Mainolfi
- Operative Unit of Diagnostic Imaging and Radiotherapy, Federico II University Hospital, I-80131 Naples, Italy
| | - Luigi Insabato
- Operative Unit of Pathology, Department of Advanced Biomedical Science, Federico II University Hospital, I-80131 Naples, Italy
| | - Rossella Accarino
- Operative Unit of Pathology, Department of Advanced Biomedical Science, Federico II University Hospital, I-80131 Naples, Italy
| | - Mario Giuliano
- Operative Unit of Medical Oncology, Department of Clinical Medicine and Surgery, Federico II University Hospital, I-80131 Naples, Italy
| | - Nicola Carlomagno
- Operative Unit of General Surgery and Kidney Transplantation, Department of Advanced Biomedical Science, Federico II University Hospital, I-80131 Naples, Italy
| | - Vincenzo D'Alessandro
- Operative Unit of General Surgery and Retroperitoneal Diseases, Department of Clinical Medicine and Surgery, Federico II University Hospital, I-80131 Naples, Italy
| | - Michele L. Santangelo
- Operative Unit of General Surgery and Kidney Transplantation, Department of Advanced Biomedical Science, Federico II University Hospital, I-80131 Naples, Italy
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3
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Deng H, Cao B, Cui H, Chen R, Li H, Zhao R, Chen L, Wei B. Clinical analysis of 5-year survival and recurrence in giant retroperitoneal liposarcoma after surgery. Chin Med J (Engl) 2023; 136:373-375. [PMID: 36804480 PMCID: PMC10106206 DOI: 10.1097/cm9.0000000000002405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Indexed: 02/22/2023] Open
Affiliation(s)
- Huan Deng
- Medical School of Chinese People's Liberation Army, Beijing 100853, China
| | - Bo Cao
- Department of General Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Hao Cui
- Department of General Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Runkai Chen
- Department of General Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Hanghang Li
- Department of General Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Ruiyang Zhao
- Department of General Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Lin Chen
- Department of General Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Bo Wei
- Medical School of Chinese People's Liberation Army, Beijing 100853, China
- Department of General Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
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Xia H, Fang F, Yuan H, Tu Y. Survival of a patient with multiple-recurrent giant retroperitoneal dedifferentiated liposarcoma for 15 years: A case report. Front Surg 2022; 9:916802. [DOI: 10.3389/fsurg.2022.916802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 10/10/2022] [Indexed: 11/09/2022] Open
Abstract
BackgroundRetroperitoneal liposarcoma (RPLS) is a variety of soft tissue sarcoma that originates from mesenchymal cells. A tumor measuring greater than 30 cm is called a “giant liposarcoma.” A part of the neoplasm tends to grow in size, recur locally, or metastasize distantly. In those with such a condition, long-term survival is uncommon. Therefore, it is necessary to present a uniform and optimized program to improve the prognosis.MethodsBy successfully treating a multiple-recurrent giant retroperitoneal dedifferentiated liposarcoma (RP DDLPS) in July 2010, we hope to devise more comprehensive strategies to improve diagnosis, therapy, and outcome.ResultsIn July 2010, we thoroughly resected a giant multifocal RPLS with a concomitant part of the gastric wall. The histopathological examination revealed a high-grade (grade III) dedifferentiated liposarcoma. The patient was discharged uneventfully on the 15th postoperative day. She relapsed after 16 months and needed another complete excision. After 9 months, she died after the fourth recidive. The patient had experienced four recurrences and underwent operations with 15 years of follow-up.ConclusionsThe above demonstrates that we were able to successfully treat the multirecurrent giant RPLS, despite the patient’s poor medical condition, with meticulous management. Moreover, this indicates that long-term survival could be achieved for high-grade RP DDLPS.
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Giant mesenteric myxoid liposarcoma: Challenges of diagnosis and treatment. Radiol Case Rep 2022; 17:4227-4231. [PMID: 36120521 PMCID: PMC9471334 DOI: 10.1016/j.radcr.2022.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 11/20/2022] Open
Abstract
Myxoid liposarcoma is the most frequent form of liposarcoma, frequently localized in the extremities. Abdominal liposarcomas more commonly arise from the retroperitoneum. However, primary mesenteric localization is extremely rare. To the best of our knowledge, 22 cases have been reported in English literature. The diagnosis is often delayed by the insidious evolution of this tumor. On radiological examination, primary mesenteric liposarcoma presents as a large mass that entrapped the small bowel loops. The treatment requires complete tumor resection. We report an observation of mesenteric myxoid liposarcoma in a 64-year-old female patient, revealed by an abdominal mass associated with abdominal pain. The treatment consisted of complete tumor removal. Histologically, the tumor proved to be a myxoid liposarcoma. No adjuvant treatment was considered necessary. The patient recovered well after the operation. The aim of reporting this case is to present an uncommon clinical entity because of its huge dimensions, the rarity of the site, and histological pattern.
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Tani A, Tarumi Y, Kakibuchi A, Aoyama K, Kokabu T, Kataoka H, Yoriki K, Nagamine M, Mori T. Giant retroperitoneal dedifferentiated liposarcoma mimicking ovarian cancer: A case report. Gynecol Oncol Rep 2022; 44:101088. [PMID: 36299399 PMCID: PMC9589010 DOI: 10.1016/j.gore.2022.101088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/11/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
Clinical features of the dedifferentiated subtype of LPS that has a diameter of >30 cm remains unknown. Surgical resection entails a high risk due to the size and anatomical location and difficulty in preoperative diagnosis. CT is the most useful imaging method for evaluating tumor location, size, origin, and relationship to adjacent organs. Retroperitoneal LPS should be considered in the case of a giant intra-abdominal tumor with a fatty component. Surgical resection is the mainstay of treatment for retroperitoneal LPS.
Retroperitoneal liposarcoma is a rare tumor, and its dedifferentiated subtype and a larger diameter are associated with a poor prognosis. However, there are few reports of retroperitoneal liposarcomas, both with a dedifferentiated subtype and a diameter of >30 cm. We report a case of a giant retroperitoneal liposarcoma with a dedifferentiated subtype. A 78-year-old woman presented to our hospital with abdominal distension and loss of appetite. Computed tomography and magnetic resonance imaging findings revealed a 35-cm-diameter solid tumor in the peritoneal cavity. CA125 (64.8 U/mL) and HE4 (229.0 pmol/L) were elevated preoperatively raising suspicion for ovarian malignancy. However, intraoperative findings revealed that the tumor originated in the retroperitoneal cavity. Reductive surgery for the tumor and partial resection of the sigmoid colon and left ureter were performed, and pathological examination confirmed a retroperitoneal dedifferentiated liposarcoma. Although her symptoms improved postoperatively, she died 11 months after surgery due to disease progression.
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Affiliation(s)
- Akihiro Tani
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Yosuke Tarumi
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan,Corresponding author.
| | - Akiyo Kakibuchi
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Kohei Aoyama
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Tetsuya Kokabu
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Hisashi Kataoka
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Kaori Yoriki
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Michiko Nagamine
- Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Taisuke Mori
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
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Marjiyeh-Awwad R, Mansour S, Khuri S. Giant Retroperitoneal Liposarcoma: Correlation Between Size and Risk for Recurrence. World J Oncol 2022; 13:244-248. [PMID: 36406196 PMCID: PMC9635795 DOI: 10.14740/wjon1528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/03/2022] [Indexed: 11/29/2022] Open
Abstract
Soft tissue sarcomas (STSs) are rare tumors that represent almost 1% of adult malignant tumors. The annual incidence rate for such tumors is 2 - 5/100,000 population. The most common type of STS in adults is liposarcoma, which represents 15-20% of adult STSs. It is of mesodermic origin derived from adipose tissues, and known as the most common primary malignant tumor of the retroperitoneum. Other sites of involvement include the extremities, trunk and to a lesser extent the pleural cavity, esophagus, mediastinum and others. Due to the potential large retroperitoneal space, retroperitoneal liposarcoma (RPL) is usually asymptomatic during the initial phase, developing symptoms at a late stage due to large mass compressing nearby retroperitoneal structures. The average diameter and weight of RPL during diagnosis is 20 - 25 cm and 15 - 20 kg, respectively. Several factors were labelled as risk factors for recurrence, such as histological type, tumor grade, age, resectability and tumor size. Controversy exists regarding the relationship between tumor size and recurrence rate, thus, tumor size as a risk factor for recurrence should be clarified. Although there is no consensus regarding the precise definition of giant RPL, it is defined by several literatures as an RPL of greater than 30 cm in diameter or with weight of more than 20 kg. The main purpose of this article is to review the current English literature regarding giant RPL and examine the relationship between tumor size and risk for recurrence.
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Affiliation(s)
| | - Subhi Mansour
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Safi Khuri
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel,HPB and Surgical Oncology Unit, Rambam Health Care Campus, Haifa, Israel,Corresponding Author: Safi Khuri, General Surgery Department,Rambam Health Care Campus, Haa’leya Hashniya, Haifa 31096, Israel.
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Mansour S, Azzam N, Kluger Y, Khuri S. Retroperitoneal Liposarcoma: The Giant Type. J Med Cases 2022; 13:517-520. [PMID: 36407863 PMCID: PMC9635766 DOI: 10.14740/jmc4014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/21/2022] [Indexed: 01/25/2023] Open
Abstract
Retroperitoneal tumors (RPTs) are very rare tumors that arise in the large space of the retroperitoneum. About two-third of these tumors are malignant, of which soft tissue sarcoma (STS) is the most common and comprises almost one-third of malignant RPTs. Twenty to thirty percent of RPTs are benign. The retroperitoneal cavity has a very large potential space for tumor enlargement to a very high diameters without causing specific symptoms, especially during the initial phase of tumor enlargement. On diagnosis, the average tumor weight is 15 - 20 kg and tumor diameter is 20 - 25 cm. The most common retroperitoneal sarcoma type is liposarcoma, which account for 20% of all sarcoma types and 40% of all retroperitoneal sarcomas (RPSs). Other less common STS arise in the retroperitoneum include leiomyosarcoma and undifferentiated pleomorphic type. Giant liposarcoma is usually defined either as tumor diameter of 30 cm or more or tumor weight of 20 kg or higher. This specific type of sarcoma is very uncommon, with few case reports published in the English literature. Herein, we present a case of a healthy 33-year-old male patient, who was admitted due to abdominal distension and increased body weight since few months. An abdominopelvic computed tomography (CT) scan demonstrated a giant retroperitoneal mass of almost 40 cm in diameter in its largest dimension, located in the right retroperitoneal space. Ultrasound (US)-guided fine needle biopsy (FNB) was consistent with well differentiated liposarcoma. Surgical resection of the tumor along with the right colon, right ureter and kidney, third and fourth duodenal parts and part of the right iliopsoas muscle was contemplated. Histopathological report revealed well-differentiated liposarcoma of 50 cm in diameter, with foci of dedifferentiation, presented by pleomorphic sarcoma. Surgical margins were microscopically negative.
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Affiliation(s)
- Subhi Mansour
- Department of General Surgery, Rambam Medical Care Center, Haifa, Israel
| | - Nassim Azzam
- Department of General Surgery, Rambam Medical Care Center, Haifa, Israel
| | - Yoram Kluger
- Department of General Surgery, Rambam Medical Care Center, Haifa, Israel,HepatoPancreatoBiliary and Surgical Oncology Unit, Rambam Medical Care Center, Haifa, Israel
| | - Safi Khuri
- Department of General Surgery, Rambam Medical Care Center, Haifa, Israel,HepatoPancreatoBiliary and Surgical Oncology Unit, Rambam Medical Care Center, Haifa, Israel,Corresponding Author: Safi Khuri, HepatoPancreatoBiliary and Surgical Oncology Unit, General Surgery Department, Rambam Medical Care Center, Haa’leya Hashniya, Haifa 31096, Israel.
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Surgical Principles of Primary Retroperitoneal Sarcoma in the Era of Personalized Treatment: A Review of the Frontline Extended Surgery. Cancers (Basel) 2022; 14:cancers14174091. [PMID: 36077627 PMCID: PMC9454716 DOI: 10.3390/cancers14174091] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Surgery is the only curative treatment for localized disease in retroperitoneal sarcoma (RPS). Frontline extended surgery, or compartmental surgery, is a recent surgical strategy consisting of resecting the tumor together with adjacent organs, with the aim of minimizing marginality. This review provides a practical step by step description of this standardized procedure, tailored to histologic behavior, tumor localization, and patient condition. Abstract Surgery is the key treatment in retroperitoneal sarcoma (RPS), as completeness of resection is the most important prognostic factor related to treatment. Compartmental surgery/frontline extended approach is based on soft-tissue sarcoma surgical principles, and involves resecting adjacent viscera to achieve a wide negative margin. This extended approach is associated with improved local control and survival. This surgery must be tailored to tumor histology, tumor localization, and patient performance status. We herein present a review of compartmental surgery principles, covering the oncological and technical basis, and describing the tailored approach to each tumor subtype and localization in the retroperitoneum.
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Lieto E, Cardella F, Erario S, Del Sorbo G, Reginelli A, Galizia G, Urraro F, Panarese I, Auricchio A. Giant retroperitoneal liposarcoma treated with radical conservative surgery: A case report and review of literature. World J Clin Cases 2022; 10:6636-6646. [PMID: 35979304 PMCID: PMC9294896 DOI: 10.12998/wjcc.v10.i19.6636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/19/2022] [Accepted: 05/08/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Retroperitoneal liposarcoma (RLPS) is a rare malignant tumor of the connective tissue and usually grows to a large size, undetected. Diagnosis is currently based on collective findings from clinical examinations and computed tomography (CT) and magnetic resonance imaging, the latter of which show a fat density mass and possible surrounding organ involvement. Surgical resection is the main therapeutic strategy. The efficacy and safety of further therapeutic choices, such as chemotherapy and radiotherapy, are still controversial.
CASE SUMMARY A 61-year-old man presented with complaint of a large left inguinal mass that had appeared suddenly, after a slight exertion. Ultrasonography revealed an omental inguinal hernia. During further clinical examination, an enormous palpable abdominal mass, continuing from the left inguinal location, was observed. CT revealed a giant RLPS, with remarkable mass effect and wide visceral dislocation. After multidisciplinary consultation, surgical intervention was performed. Subsequent neoadjuvant chemotherapy and radiotherapy were precluded by the mass’ large size and retroperitoneal localization, features typically associated with non-response to these types of treatment. Instead, the patient underwent conservative treatment via radical surgical excision. After 1 year, his clinical condition remained good, with no radiological signs of recurrence.
CONCLUSION Conservative treatment via surgery resulted in a successful outcome for a large RLPS.
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Affiliation(s)
- Eva Lieto
- Department of Traslational Medical Sciences, University of Campania "L. Vanvitelli", Naples 80128, Campania, Italy
| | - Francesca Cardella
- Department of Traslational Medical Sciences, University of Campania "L. Vanvitelli", Naples 80128, Campania, Italy
| | - Silvia Erario
- Department of Traslational Medical Sciences, University of Campania "L. Vanvitelli", Naples 80128, Campania, Italy
| | - Giovanni Del Sorbo
- Department of Traslational Medical Sciences, University of Campania "L. Vanvitelli", Naples 80128, Campania, Italy
| | - Alfonso Reginelli
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples 80138, Campania, Italy
| | - Gennaro Galizia
- Department of Traslational Medical Sciences, University of Campania "L. Vanvitelli", Naples 80128, Campania, Italy
| | - Fabrizio Urraro
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples 80138, Campania, Italy
| | - Iacopo Panarese
- Depatment of Pathology Unit-Menthal Health, University of Campania "L. Vanvitelli", Naples 80132, Campania, Italy
| | - Annamaria Auricchio
- Department of Traslational Medical Sciences, University of Campania "L. Vanvitelli", Naples 80128, Campania, Italy
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Zhuang A, Zhao M, Fang Y, Ma L, Lu W, Zhou Y, Zhang Y, Tong H. Unplanned reoperation after resection of retroperitoneal sarcoma: experience based on a high-volume sarcoma center. World J Surg Oncol 2022; 20:158. [PMID: 35585636 PMCID: PMC9116015 DOI: 10.1186/s12957-022-02633-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most retroperitoneal sarcoma (RPS) operations require combined multi-organ resection, and the proportion of unplanned reoperation is high. However, there are no relevant studies on reoperation for RPS. METHODS Patients who underwent at least once unplanned reoperation at Shanghai Public Health Clinical Center, Fudan University, China, from August 2009 to December 2021 were retrospectively analyzed. The baseline characteristics, primary surgery, and reoperation information, postoperative complications, and survival were analyzed. RESULTS A total of 51 patients were included. Among them, 21 (41.2%) were male and 30 (58.8%) were female. The median age was 51 (interquartile range [IQR], 49-63) years. Most (88.3%) had a history of abdominal surgery. Dedifferentiated liposarcoma, well-differentiated liposarcoma, leiomyosarcoma, and others accounted for 50.9%, 21.6%, 15.7%, and 11.8%, respectively. The conditions of the primary operation were as follows: 35 (68.6%) patients achieved complete surgical resection, 48 patients had combined organ resection, and a median of 3 (IQR, 2-4) organs was removed, of which 5 (9.9%) were combined with pancreaticoduodenectomy. The median operative time was 330 (IQR, 245-440) min, and the median estimated blood loss was 1500 (IQR, 500-2600) ml. The median postoperative hospital stay was 42 (IQR, 23-82) days. For reoperation, the most common reasons were bleeding (31.3%), complications related to intestinal anastomosis (27.4%), and intestinal perforation (19.9%). The mortality rate after reoperation was 39.2% (20/51). Twelve (23.5%) patients underwent reoperation at least twice. CONCLUSIONS Unplanned reoperation among retroperitoneal sarcoma correlates with established measures of surgical quality.
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Affiliation(s)
- Aobo Zhuang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Mingkun Zhao
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yuan Fang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Lijie Ma
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Weiqi Lu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yuhong Zhou
- Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yong Zhang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China. .,Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
| | - Hanxing Tong
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China. .,Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
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12
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Retroperitoneal Sarcoma Care in 2021. Cancers (Basel) 2022; 14:cancers14051293. [PMID: 35267600 PMCID: PMC8909774 DOI: 10.3390/cancers14051293] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/22/2022] [Accepted: 02/27/2022] [Indexed: 12/16/2022] Open
Abstract
Soft-tissue sarcomas are biologically heterogenous tumors arising from connective tissues with over 100 subtypes. Although sarcomas account for <1% of all adult malignancies, retroperitoneal sarcomas are a distinct subgroup accounting for <10% of all sarcomatous tumors. There have been considerable advancements in the understanding and treatment of retroperitoneal sarcoma in the last decade, with standard treatment consisting of upfront primary surgical resection. The evidence surrounding the addition of radiation therapy remains controversial. There remains no standard with regards to systemic therapy, including immunotherapy. Adjunctive therapy remains largely dictated by expert consensus and preferences at individual centers or participation in clinical trials. In this 2021 review, we detail the anatomical boundaries of the retroperitoneum, clinical characteristics, contemporary standard of care and well as recent advancements in retroperitoneal sarcoma care. Ongoing international collaborations are encouraged to advance our understanding of this complex disease.
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Coco D, Leanza S, Reina GA. Giant Retroperitoneal Mass: Case Report in a Primary Hospital and Review of the Literature. MAEDICA 2022; 17:226-229. [PMID: 35733757 PMCID: PMC9168591 DOI: 10.26574/maedica.2022.17.1.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Retroperitoneal liposarcoma (RPLS) is a rare form of cancer that mostly affects adults. Symptoms may be undetected unless the tumor begins to grow. Diagnosis is made when the tumor is large and puts vital organs such as the pancreas, liver, kidneys at risk. Symptoms of a liposarcoma depend on tumor location. Liposarcoma in the arms, legs, particularly thighs may be painful, swollen, with patients citing weakness in the affected area; 15% of soft tissue sarcomas are retroperitoneal, with two of the most common types being the well-differentiated liposarcoma (WDLPS) and high-grade dedifferentiated liposarcoma (DDLPS). The tumor can weigh between 15 kg and 20 kg, with 20 to 25 cm in diameter (4). Surgery is the main form of treatment provided along with adjuvant therapies. We present the case of a 60-year-old woman who was referred to the Emergency Department with acute onset of abdominal distension, nausea, vomiting, right back pain, lipothymia and a giant abdominal mass.
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Affiliation(s)
- Danilo Coco
- Department of General Surgery, S. Salvatore Hospital, Paterno', S. M. Addolorata Hospital, Biancavilla, Italy
| | - Silvana Leanza
- Department of General Surgery, Carlo Urbani Hospital, Jesi, Ancona, Italy
| | - Giuseppe Angelo Reina
- Department of General Surgery, S. Salvatore Hospital, Paterno', S. M. Addolorata Hospital, Biancavilla, Italy
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14
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Li WX, Tong HX, Lv CT, Yang H, Zhao G, Lu WQ, Zhang Y. Management of retroperitoneal sarcoma involving the iliac artery: Single-center surgical experience. World J Clin Cases 2022; 10:811-819. [PMID: 35127897 PMCID: PMC8790436 DOI: 10.12998/wjcc.v10.i3.811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/15/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Management of retroperitoneal sarcoma (RPS) involving the iliac artery is challenging and requires the concerted efforts of multidisciplinary team (MDT) members during surgical treatment.
AIM To summarize the clinicopathologic features of RPS involving the iliac artery and our retroperitoneal soft tissue tumor MDT surgical experience.
METHODS In this retrospective study, 15 patients with RPS involving the iliac artery who underwent surgery at our retroperitoneal soft tissue tumor center from July 2004 to June 2020 were analyzed. Statistical analyses were performed by Student’s t-test with SPSS 16.0.
RESULTS Complete tumor resection (R0/R1) and iliac artery reconstruction were achieved in all 15 patients. All the operations were successful, with no serious complications or perioperative death. Resection with bilateral iliac artery reconstruction required a higher intraoperative blood transfusion volume than resection with unilateral iliac artery reconstruction. Recurrent cases were more likely to bleed and required a higher blood transfusion volume than primary cases. As of January 2021, 11 patients were alive, and 4 had died. Local recurrence occurred in two patients, one of whom developed liver metastasis.
CONCLUSION Resection of RPS involving iliac vessels is feasible and effective when performed by MDT members. Iliac artery oncovascular resection and reconstruction are key to a successful operation. Adequate blood preparation is important for successful completion of surgery.
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Affiliation(s)
- Wen-Xiang Li
- Department of General Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai 200083, China
| | - Han-Xing Tong
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Chen-Tao Lv
- Department of General Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai 200083, China
| | - Hua Yang
- Department of General Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai 200083, China
| | - Gang Zhao
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Wei-Qi Lu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Yong Zhang
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
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