Giant retroperitoneal liposarcoma with spread to the upper third of the left thigh

Abstract

Background. Large tumors, such as giant liposarcoma, are a challenge for modern medicine because of difficulty of treatment and possible impact on functions of the adjacent tissues and organs. The review of this clinical case may help develop new strategies and approaches to treatment of similar pathologies. Purpose. Review of the clinical case has a goal to educate medical specialists and students by helping to expand their understanding of rare oncologic diseases and to prove high effectiveness of surgery in locally advanced types of retroperitoneal liposarcomas using the clinical case as an example. Materials and methods. Female patient C., 56 years old, sought for medical help in the clinical unit of State Organization «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine» in June 2021. The following diagnosis was established: retroperitoneal liposarcoma with spread to the left thigh, St. II–ІІІ сТ3N0M0. An en-bloc surgery (removal of the retroperitoneal tumor with mobilization of the left ureter, intraabdominal removal of the thigh part of the tumor of the left thigh from beneath the inguinal ligament) was performed after the standard preoperative preparation. The surgery went without complications. The wound healed primarily. The follow-up period of the patient was 16 months. Clinical laboratory examination did not show any local recurrences and distant metastases. Results. For retroperitoneal sarcoma, the goal of surgery is to achieve the complete resection of the tumor (R0). Partial removal (R2) tumor should be strongly avoided, as this has been demonstrated to have higher recurrence risk and a detrimental effect on oncologic outcomes. The tumor involvement of organs and structures does necessitate concomitant resection. Resection of one or more adjacent organs is carried out in 58–87% of all cases of primary RPS. Most commonly, ipsilateral nephrectomy and partial colectomy are also performed. In cases of hypothetical necessity of removing all adjacent organs, an extended or compartmental approach to resection is recommended. The main idea is to resect not only evidently affected organs but also surfaces to obtain circumferential «soft tissue margins». This approach is controversial but data from some sarcoma care centers in Italy and France indicate its effectiveness. Conclusions. Treating RPS in specialized centers of oncosurgery with surgical planning based on CT and MRI data is of vital importance, especially using assessment by related surgical specialists. In large RPS, achieving a classic R0 resection level is a challenge, even in a compartmental approach, therefore division of resections into R2 and R0/R1 is reasonable. The choice of approach determines success of the surgery due to the narrowness of the surgical field.