Danby Kang, MD1, Thea Price1, Ernest Rosato, MD2. 1Rush University Medical Center, 2Thomas Jefferson University Hospitals, Department of Surgery
Retroperitoneal tumors generally require laparotomy and large en bloc resection for R0 excision due to difficult access, small working space, surrounding major vascular structures, and variable anatomy. Additionally due to location, retroperitoneal tumors tend to have an insidious course, presenting at an advanced stage at the time of diagnosis.
We present a case of a 63 year-old woman with a history of endometrial cancer who was referred for evaluation of a mass incidentally found on computed tomography (CT) scan. The scan showed a circumscribed heterogeneous mass superior to the portal vein, at the junction of pancreatic head and neck, measuring 2.8cm x 2.5cm x 2.0cm. CT guided percutaneous biopsy showed atypical spindle cells and soft tissue fragments.
She was taken to the operating room for a diagnostic laparoscopy with a plan to perform an open pancreaticoduodenectomy versus a laparoscopic enucleation if the mass appeared well-circumscribed and non-infiltrating. Upon laparoscopic entry into the retroperitoneum, a soft tissue mass at the superior border of the neck of the pancreas was identified. The mass was carefully dissected and found to be adherent to but not infiltrating the portal-splenic-superior mesenteric vein confluence. This tumor was removed using LigaSure® and hook cautery, with careful preservation the venous structures. The entire procedure was captured via laparoscopic video recording.
Final surgical pathology showed a leiomyosarcoma with Ki-67 of 23.75% and 4-6 mitotic figures per 10 high power field. She underwent radiation therapy due to a positive margin. She has been followed for 2 years by oncology with MRI surveillance and has no evidence of recurrent disease.
Retroperitoneal leiomyosarcoma is a rare entity that poses both diagnostic and therapeutic challenge for even the experienced surgeons, especially in the setting of prior abdominal malignancy. We propose the use of laparoscopy as an emerging technique in diagnostic, intraoperative decision making, and treatment modality of retroperitoneal tumors.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 90995
Program Number: ETP858
Presentation Session: Emerging Technology iPoster Session (Non CME)
Presentation Type: Poster