Jamii St. Julien, MD, MPH, Elizabeth Grubbs, MD, FACS, Nancy D Perrier, MD, FACS, Jeffrey E Lee, MD, FACS. MD Anderson Cancer Center
Background: Patients with small retroperitoneal tumors difficult to access by traditional anterior laparoscopic techniques are often subjected to open operations, with significant associated discomfort and relatively longer recovery times. Minimally invasive posterior retroperitoneoscopic adrenalectomy has been demonstrated to be both safe and effective when compared to the anterior approach. We have found a similar posterior minimally invasive approach useful for other tumors of the retroperitoneum, and here we review our experience with the posterior retroperitoneoscopic approach applied to patients with extra-adrenal tumor processes.
Methods: We performed a retrospective analysis of all patients who underwent posterior retroperitoneoscopic resection or excisional biopsy of extra-adrenal tumor processes from 2005-2015. Outcome measures included procedural (diagnostic or therapeutic) success, complications, and length of stay.
Results: Twenty-eight operations were performed. Mean age was 49 years (SD 13.6). Mean BMI was 31kg/m2 (SD 7.2); 42% of patients had a BMI ≥30. Laterality was evenly split between the right and left sides; 61% of patients had undergone at least one prior abdominal operation. Mean tumor size was 2.9cm (SD 1.4), mean operative time was 123 minutes (SD 58.4), and median blood loss was 25mL. Twelve patients (43%) underwent the operation for diagnosis, 12 for therapeutic intent, and 4 (14%) for combined reasons. Final pathologic diagnoses included lymphoma, paraganglioma, as well as recurrent adrenocortical carcinoma and pheochromocytoma, and metastatic melanoma, gastrointestinal stromal tumor, neuroendocrine carcinoma, non-small cell lung cancer, and pancreatic adenocarcinoma. The procedure was considered successful in 25 of 28 operations (89%). Median length of stay was 1 day. There was one complication (3.6%), two patients underwent conversion to an open operation (7.1%), and there was no operative mortality.
Conclusion: The posterior retroperitoneoscopic approach for extra-adrenal tumors is safe and feasible in carefully selected patients. Operative time, complication rates, and conversion rates appear to be similar to those reported for retroperitoneoscopic adrenalectomy. Surgeon experience and careful preoperative planning are critical to success.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79400
Program Number: P581
Presentation Session: Poster (Non CME)
Presentation Type: Poster
