Abstract
The retroperitoneum can host a wide variety of pathologies, including benign and malignant tumors. Primary retroperitoneal tumors are rare, usually large in size, more than half of them being larger than 20 cm at the time of diagnosis, due to their silent growth. They often present several therapeutic challenges because of their rarity, relatively late presentation and anatomical location, often in close relationship with several important structures in the retroperitoneal space. Extensive surgery is often required because of the intimate relationships with vital organs in the retroperitoneum. Retroperitoneal sarcomas frequently involve major vessels, originating from them or secondarily encase or invade them, requiring major vascular resections, with increasing morbidity. The main intervention that can increase the survival of patients with retroperitoneal tumors is radical resection. The involvement of large retroperitoneal vessels often makes impossible a radical intervention, usually because of the lack of an adequate material for ample and laborious vascular reconstruction. In this paper, a thorough search of the PubMed database was performed, to bring into the light the implications of vascular involvement in primary retroperitoneal tumors and the need of a strong cooperation between the urological or general surgeon and the vascular surgeon.
Highlights
The retroperitoneum can host a wide variety of pathologies, including benign and malignant tumors
Connective tissue, kidneys, adrenals, ureters, aorta with its emerging branches, inferior vena cava and other important vessels, lymph nodes, the pancreas as well as segments of the duodenum and colon are all part of the retroperitoneum. This space can host a wide spectrum of pathologies
The two most frequent histological subtypes of sarcomas are liposarcomas (70%) and leiomyosarcomas (15%), tumors that present as hard abdominal masses with an irregular surface, surrounded by a capsule that is rapidly outgrown by tumor growth and inûltrate the peritoneum and the intra-abdominal viscera attached to it, becoming directly intraperitoneal, and not by metastatic invasion [4,5]
Summary
The retroperitoneum can host a wide variety of pathologies, including benign and malignant tumors. The authors concluded that the need for vascular resection and reconstruction should not be a deterrent to resection for patients with sarcoma, as the oncologic outcome (overall and local recurrence-free survival) seems to be similar to that encountered in the cases where the vascular invasion is absent [37,38].
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