Laparoscopic removal of a giant retroperitoneal sarcoma

Hugo Bonatti. University of Maryland; Memorial Hospital at Easton

Background: Liposarcomas are the most common retroperitoneal soft tissue malignancy and can grow to significant size. Radical resection with clear margins is the main stem of successful therapy. Only few cases of laparoscopic resection have been reported

Case Report: A 76 year old woman complained of fullness in her abdomen and underwent a CT-scan showing a 20x10x8cm mass in the right retroperitoneum displacing duodenum and right colon to the left abdomen and the kidney cranially and anteriorly. Initially this was thought to be a kidney cyst as there were liquid areas and a percutaneous drainage was attempted; aspiration revealed a low grade liposarcoma. We suggested laparoscopic mobilization and extraction through a lower midline scar (patient had an abdominal hysterectomy). Four trocars (5mm in left upper and lower quadrant and in lower midline, 15mm in lower midline) were placed; with the EnSeal first the right and transverse colon were dissected off the tumor. Next the duodenum was removed from the sarcoma and the infrarenal vena cava was freed. The right ureter had been stented and the tumor was lifted off it. The white line of Told was incised and the sarcoma was dissected off laterally and dorsally. The tissue between tumor and liver was cut. The Gerota fascia was divided and the right kidney was mobilized. The renal pelvis was dissected off the sarcoma. The tumor was lobulated in this area with a portion reaching over the renal pelvis. Once the entire kidney was seperated from the sarcoma last adhesions to the Gerota fascia were divided and the tumor was placed into a large retrieval bag. The preexcisting midline incision including the two trocar sites was re-ropened for 8cm and the bag with the tumor was removed. The patient had an unremarkable recovery and histopathology confirmed low grade liposarcoma with intact capsule and negative margins. The tumor reached the resection margin where it was cut off the kidney. No additional treatment was initiated and the patient is well at 3 months follow up.

Conclusions: This is to the best of our knowledge the largest retroperitoneal sarcoma ever laparoscopically removed. In selected cases, such large tumors can be targeted by a minimal access approach.

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