Clinical Experience of Primary Retroperitoneal Tumor: Report of 600 Cases

Objective： To summarize the experience of management for primary retroperitoneal tumor （PRPT） and to analyze the factors influencing the outcome after operation. Methods： The data of 600 cases of PRPT in General Hospital of PLA were reviewed retrospectively. Results： Of 600 cases of PRPT, 546 were surgically treated. Among theme 369 were malignant and 177 benign. 366 cases were followed up for 1 month to 15 years. The 1-years 3-year, and 5-year survival rate in the patients subject to complete resection was 90.5%, 73.2% and 53.6%, respectively, and that in incomplete resection patients was 70.6%, 32.0%, 5.7% respectively （P〈0.01）. The Cox multi-various regression analysis revealed showed completeness of tumor resection, sex and histologic type were associated closely with local recurrence. Conclusion： Sufficient preoperative preparation and complete tumor resection play important roles for reducing recurrence and improving survival.

Surgical management of 143 patients with adult primary retroperitoneal tumor

AIM： To analyze the surgical management of adult primary retroperitoneal tumors （APRT） and the factors influencing the outcome after operation. METHODS： Data of 143 cases of APRT from 1990 to 2003 in the First Affiliated Hospital of China Hedical University were evaluated retrospectively. RESULTS： A total of 143 cases of APRT were treated surgically. Among them, 122 （85.3%） underwent complete resection, 16 （11.2%） incomplete resection, and 3 （3%） surgical biopsies. Twenty-nine （20.2%） underwent tumor resection plus multiple organ resections. Ninety-five malignant cases were followed up for 1 mo to 5 years. The 1-year, 3-year, and 5-year survival rates of the patients subject to complete resection was 94.9%, 76.6% and 34.3% and that of patients with incomplete resection was 80.4%, 6.7%, and 0%, respectively （P 〈 0.001）. The Cox multi-various regression analysis showed the completeness of tumor, sex and histological type were associated closely with local recurrence. CONCLUSION： Sufficient preoperative preparation and complete tumor resection play important roles in redudng recurrence and improving survival.

Intra and extra pelvic multidisciplinary surgical approach of retroperitoneal sarcoma:Case series report

BACKGROUND Retroperitoneal sarcoma(RPS) is a rare malignancy arising from mesenchymal cells that most commonly presents as an abdominal mass and is associated with poor prognosis.Although several studies have assessed the survival benefits of wide excision,few have reported detailed methods for achieving wide excision in patients with RPS.AIM To describe our experience with multidisciplinary surgical resection of RPS using intra-and extra-pelvic approaches.METHODS Multidisciplinary surgery is an anatomical approach that combines intra-and extra-peritoneal access within the same surgery to achieve complete RPS removal.This retrospective review of the records of patients who underwent multidisciplinary surgery for RPS analyzed surgical and survival outcomes.RESULTS Eight patients underwent 10 intra-and extra-pelvic surgical resections,and their median mass size was 12.75 cm(range,6-45.5 cm).Using an intrapelvic approach,laparoscopy-assisted surgery was performed in four cases and laparotomy surgery in six.Using an extrapelvic approach,ilioinguinal and posterior approaches were used in four cases each,and the prone position and midline skin incision were shared in one.All patients’ RPS masses were removed completely,and four achieved R0 resection through intra-and extra-pelvic surgery.The median estimated blood loss was 2000 m L(range,300-20000 m L) and the median hospitalization was 12.6 d(range,9-69 d).Reoperation was needed in two patients(one for wound necrosis and the other for bowel perforation and wound necrosis).The median overall survival rate and median progression-free survival were 64.6 and 13.7 mo,respectively.CONCLUSION RPS is therapeutically challenging because of its location and high risk of recurrence.Therefore,intra-and extra-pelvic surgical approaches can improve the macroscopic security of the surgical margin.

Solitary extramedullary plasmacytoma in retroperitoneum:A case report and review of the literature

Extramedullary plasmacytoma(EPM) is a plasma cell tumor arising outside of the bone marrow.Solitary EMP is an uncommon neoplasm and rarely occurs in the retroperitoneum and lacks distinctive clinical manifestations.We report a 26-year-old man with a solitary EMP in the retroperitoneum and discuss its clinical features,diagnosis and treatment.

Prognostic Factors Predicting the Postoperative Survival Period Following Treatment for Primary Retroperitoneal Liposarcoma

Background：Liposarcomas,which represent 20% of all adult sarcomas,are the most common histological type of malignant soft tissue tumors.The aim of this study was to define the prognostic factors that predict the postoperative survival period for patients with primary retroperitoneal liposarcoma.Methods：The clinical data and prognoses of 71 patients with primary retroperitoneal liposarcoma who were treated in the General Hospital of the People＇s Liberation Army of China between January 1,2000 and December 31,2007 were retrospectively reviewed and analyzed.Results：The primary tumor from each patient was resected; 54.9% （39/71） were deemed R0 resections,31.0% （22/71） were R1 resections and 14.1% （10/7 l） were deemed R2 resections （palliative operations）.The median follow up was 68 months （range：1-160 months）.Of the patients who received an R1 or R2 resection of their primary tumor,96.7% （59/61） had tumor recurrence.The 1-year,3-year,and 5-year recurrence-free rates were 77.0%,29.8% and 19.7%,respectively.As of April 2013,53 of the 71 patients had died from tumor recurrence.The overall l-year,3-year,5-year,and 10-year survival rates were 88.7%,76.1%,61.7%,and 30.4%,respectively.The factors that were significantly associated with prognosis in the univariate analysis were age （as a categorical variable） （P =0.006）,modus operandi （P =0.000）,histologic subtype （P =0.000）,tumor grade （P =0.000）,ascites （P =0.000）,postoperative metastasis （P =0.000） and adjuvant therapy （P =0.030）.However,in the multivariate analysis,the modus operandi （P =0.000）,tumor grade （P =0.006）,ascites （P =0.027）,postoperative metastasis （P =0.023） and age （as a categorical variable） （P =0.002） were the only significant predictors of survival.Conclusions：Complete resection remains the most effective method for treating liposarcoma.High grade,old age （≥60 years old）,postoperative metastasis,and ascites predict poor prognoses.

Metachronous multicentric giant cell tumor of bone with retroperitoneal metastasis

Giant cell tuenor （GCT）of bone is a benign but locally aggressive tumor that usually involves the epiphysis of long bones.1Rarely,these tumors metastasize to the lung, and these metastases generally have the same benign histological appearance as the primary tumor. Multicentric giant cell tumor （M-GCT） is rarer. We herein report a case of M-GCT involving the left distal radius, with retroperitoneal metastasis, and subsequent lesions in the left proximal and distal femur. The patient and family members were informed that data concerning the case would be submitted for publication, and they consented.

Prognostic factors of retroperitoneal soft tissue sarcomas:analysis of 132 cases

Background Retroperitoneal sarcoma is a rare disease with poor prognosis. The aim of this study was to investigate the prognostic factors of the disease. Methods Between January 1988 and December 2003, 132 patients with retroperitoneal sarcoma were surgically treated in our hospital, 79 of them were followed up for 1-122 months （median： 19 months）. Their clinicopathological data including tumor size, histological subtype, grade and resection margin status, were studied. The Kaplan-Meier method and log-rank test were used to analyze the disease-specific survival rates after the resection. Results Among the 132 patients, 98 （74.2%） received macroscopic complete resection, 29 （22.0%） incomplete resection, and 5 （3.8%） surgical biopsy. In the 79 patients who were followed up, macroscopic clear resection of retroperitoneal sarcoma （n=49） was associated with a significantly higher survival rate compared with unclear resection （n=30, P〈 0.001）. The median survival period was 31 months （95%Cl, 20.09-41.91; actuarial 1-year survival, 85.7%） in the patients with the tumor completely resected and 11 months （95%Cl, 6.71-15.29; actuarial 1-year survival, 46.7%） in those with incomplete resection. Patients with high-grade sarcomas had a significantly shorter survival time （n=39; median： 24, 95%Cl： 5.71-42.29） than those with low-grade sarcomas （n=40; median： 15; 95%Cl： 8.80-21.20; P〈0.01）. Moreover, compared with the patients with the tumor sized 〈15 cm in diameter （n=53）, the survival rate was lower in those with a sarcoma sized 〉15 cm （n=26）. （Median： 12. 95%Cl： 8.26-15.74 vs median： 24, 95%Cl： 17.25-30.75; P〈 0.05）. Furthermore, the survival of the patients with liposarcomas （n=29, median： 29, 95%Cl： 12.84-45.16）, leiomyosarcomas （n=14, median： 11, 95%Cl： 6.11-15.89）, and others （n=-36, median： 22, 95%C/： 14.95-29.05） varied significantly （P〈0.05） Conclusion Completeness of resection, tumor volume, grade, and subtype are prognostic factors of retroperitoneal soft tissue sarcomas.