On August 7, 2024, the multidisciplinary team (MDT) from the First Affiliated Hospital (FAH) of Xi'an Jiaotong University (XJTU) successfully completed the first case of "horse dismounting" en bloc resection of recurrent retroperitoneal sarcoma combined with the right kidney and inferior vena cava, autologous heterotopic kidney transplantation and inferior vena cava reconstruction in China.
A 39-year-old female patient, surnamed Shi, underwent retroperitoneal tumor resection 1 year ago due to retroperitoneal leiomyosarcoma, and was orally treated with targeted drugs after operation. In March, 2024, the tumor recurred, grew into the inferior vena cava and invaded surrounding tissues. Surgical resection of retroperitoneal tumor is risky and extremely challenging, and tumor recurrence in this case increased the difficulty. She was admitted to the outpatient of Professor Wang Shufeng from Department of General Surgery of FAH. Professor Wang stressed that the patient's condition was extremely complicated, and the gradual progression of the tumor will be life-threatening if surgery were not performed.
Considering the special tumor location and the difficulty of surgery, MDT team comprising more than 10 professors, including Professor Wang Shufeng and Li Xuqi from Department of General Surgery, Professor Tian Puxun from Department of Kidney Transplantation, Professor Wang Zheng from Department of Hepatobiliary Surgery, Professor Zhang Chun from surgical ICU and Professor Wang Qiuping from Department of Radiology, determined an innovative surgical protocol after three rounds of MDT consultations. On August 7, under the assistance of Department of Anesthesiology and Perioperative Medicine, the team led by Professor Wang Shufeng, Professor Tian Puxun and Professor Wang Zheng performed the surgery. During the operation, Professor Wang Shufeng's team performed "horse dismounting" en bloc resection of the tumor along with the right kidney and inferior vena cava, and subsequently Professor Tian Puxun's team carefully and completely stripped the right kidney from the tumor on the kidney repair table for kidney repair and perfusion to ensure no residue tumor. Meantime, Professor Wang Zheng's team joined hands with Professor Li Xuqi from Department of General Surgery to immediately carry out artificial vascular replacement and minimize the ischemic time of organs. Finally, the repaired autologous kidney was successfully transplanted into the iliac fossa of the patient, and vascular anastomosis of all organs and ureterostomy of the kidney were carried out. The 11-h surgery was successfully completed. Postoperatively, the patient was transferred to surgical ICU. Under effective treatment, attentive nursing and fined management of medical staff, the patient successfully overcame blood coagulation disorder, the risk of thrombosis and postoperative abdominal infection, and successfully returned to the general ward.
The most significant innovation of this procedure is to adopt the "horse dismounting" pattern, i.e., incising the huge tumor with severe adhesion in vivo and stripping it in vitro. It properly protects the organ function, significantly enhances clinical efficacy, preserves the right kidney and minimizes the recurrence rate of tumors. According to literature review, this is the first case of "horse dismounting" en bloc resection of recurrent retroperitoneal sarcoma combined with the right kidney and inferior vena cava, autologous heterotopic kidney transplantation and inferior vena cava reconstruction in China, which paves a new way for the treatment of such patients in the future and marks that surgical technologies of FAH have reached international advanced levels.
