Frontline aggressive surgical approach in retroperitoneal sarcoma improved patients' outcome in terms of local disease control and overall survival in several recent international series. We present the technique of retroperitoneal multivisceral resection, as standardized in recent years at Fondazione IRCCS Istituto Nazionale dei Tumori (Milan, Italy) in the form of a six stages procedure.
Stage 1: exploration and exposure; stage 2: division of right colon and distal ileum; stage 3: assessment of duodenum and Kocher maneuver; stage 4: dissection of inferior vena cava and ligation of renal vessels; stage 5: regional peritonectomy and psoas resection; stage 6: liberation of costodiaphragmatic fold and specimen removal.
Retroperitoneal multivisceral resection is recognized as mainstay of treatment for localised primary retroperitoneal sarcoma; complete resection rate is close to 96% in most recent series, even though local failure still represents a challenge. Despite the various clinical and anatomic presentation of retroperitoneal sarcoma, this standardized approach may guide the surgeon to plan surgery, in order to successfully complete the intervention in a safe and effective manner.
Case patient: A classical right retroperitoneal dedifferentiated liposarcoma in a 63 year male with no previous medical history is presented. As an incidental finding, a huge mass in the right retroperitoneal space of 22cm in size was found at CT scan. Percutaneous biopsy was obtained with diagnosis of dedifferentiated liposarcoma. After multidisciplinary discussion, the patient was candidate to frontline surgery. Surgical procedure has been conducted according to the standardized six stages technique of retroperitoneal multivisceral resection.