Abstract
BackgroundRetroperitoneal tumors are an uncommon disease known to consist of a diverse group of benign and malignant neoplasms. Treatment of unresectable retroperitoneal lesions requires pathological diagnosis. Here, we report the utility and safety of retroperitoneoscopic biopsy for unresectable retroperitoneal lesions excluding urogenital cancers.MethodsWe analyzed 47 patients consisting of 23 (49%) and 24 (51%) cases that underwent retroperitoneoscopic tissue biopsy and open biopsy, respectively. The clinicopathological features, including postoperative complications, were compared between the two groups.ResultsTumor pathology was diagnosed successfully with a single operation in all patients. Malignant pathology (68%) was more common than benign pathology (32%). The most common pathology was malignant lymphoma, which accounted for about 50% of all cases. There was no significant difference with respect to the age, sex, tumor size, presence of tumor-related symptom, histopathology, operative time, and complications. Three (13%) of 23 patients in the retroperitoneoscopic biopsy group received percutaneous needle biopsy before laparoscopic excisional biopsy because the evaluation of needle cores failed to confirm subclasses of diagnosed pathologies. One patient was converted to open surgery just after the initiation of operation due to severe adhesion of adjacent structures. We had two cases with iatrogenic urinoma due to ureteral injury after retroperitoneoscopic biopsy.ConclusionsWe conclude that retroperitoneoscopic biopsy is a safe and useful tool for benign and malignant retroperitoneal lesions, in comparison to open biopsy. It is critical to carefully examine the preoperative imaging for the location of tumors, especially those close to the renal pelvis and ureter.
Highlights
Retroperitoneal tumors are an uncommon disease known to consist of a diverse group of benign and malignant tumors
A subset of patients has surgically unresectable retroperitoneal lesions, which are frequently indicated for tissue biopsy by means of computed tomography (CT)-guided needle biopsy, ultrasound-guided needle biopsy, or laparoscopic biopsy [10,11,12]
Image-guided needle core biopsy or fine-needle aspiration (FNA) is a noninvasive and inexpensive procedure, one of the limitations is that a pathological evaluation of needle biopsy sometimes fails to confirm subclasses of lymphoma, sarcoma, and other neoplastic diseases due to insufficient amount of tissue specimens [13, 14], which could cause inappropriate treatment and delayed interventions
Summary
Retroperitoneal tumors are an uncommon disease known to consist of a diverse group of benign and malignant tumors. The best therapeutic option is a surgical removal accompanied with extended resection of margins and adjacent organs, especially for retroperitoneal soft tissue sarcomas [2,3,4,5]. According to the NCI Dictionary of Cancer Terms, “unresectable” is defined as being unable to be removed with surgery due to spreading to the tissues around the primary lesion. “Undetectable lesion” is defined as tumors which are unable to be removed with surgery due to its size, location, and/or expansion to surrounding organs. Retroperitoneal tumors are an uncommon disease known to consist of a diverse group of benign and malignant neoplasms. We report the utility and safety of retroperitoneoscopic biopsy for unresectable retroperitoneal lesions excluding urogenital cancers
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