Recently, MDT complex retroperitoneal tumor team led by Professor Wang Shufeng from Department of General Surgery of the First Affiliated Hospital (FAH) of Xi'an Jiaotong University (XJTU) delivered clinical diagnosis and treatment for a patient with a huge retroperitoneal tumor in the right thoracoabdominal junction, and successfully performed surgical resection. The patient was discharged after postoperative recovery.
A 53-year-old male patient, surnamed Zhang, developed asthma and abdominal distension for 1 month. CT scan in a local hospital showed that "a huge retroperitoneal tumor complicated with right thoracic tumor", and he was recommended to receive treatment from Professor Wang Shufeng from Department of General Surgery in FAH.
After admission, Professor Wang Shufeng's team carried out comprehensive physical assessment. Imaging results detected a huge retroperitoneal tumor in the right abdomen from the lower margin to the right iliac fossa, penetrating through the diaphragm to the posterior costal diaphragm angle of the chest cavity, involving the portahepatis, and the liver and left kidney were displaced forward and left under compression, and the boundary between the lesion and the right psoas major was unclear. The thrombosis was observed at the proximal segment of superior mesenteric artery, invaded into the lesion at the distal end, and a large quantity of branches provided blood supply to the tumor. The right renal artery surrounded the anterior margin of the tumor and branches delivered blood supply to the tumor. The right common iliac artery and external iliac artery were located at the posterior margin of the tumor and were displaced under compression. The main and right branches of portal vein were located at the anterior margin of tumor and displaced under compression. The inferior vena cava and superior mesenteric vein were located at the left margin of the tumor and also displaced under compression. The function of the left kidney was significantly impaired. After a series of preoperative evaluation, he was diagnosed with retroperitoneal tumor in the thoracoabdominal junction, which was located in a special site and intimately associated with surrounding organs, tissues and vessels. The procedure was extremely challenging, and it was impossible to complete such complicated procedure without MDT cooperation.
MDT complex retroperitoneal tumor team, consisting of Department of General Surgery, Department of Hepatobiliary Surgery, Department of Thoracic Surgery, Department of Urology, Department of Radiology, Department of Vascular Surgery, surgical ICU, Department of Anesthesiology and Perioperative Medicine and Department of Pathology, delivered collective discussion and jointly determined specific regimens of preoperative treatment, surgical resection, intraoperative monitoring, postoperative treatment and rehabilitation.
With the cooperation of Department of Anesthesiology and Perioperative Medicine and Operating Room, Professor Wang Shufeng's team, Professor Wang Zheng from Department of Hepatobiliary Surgery and Professor Wang Zhe from Department of Thoracic Surgery successfully performed "thoracoabdominal surgical resection of retroperitoneal giant tumor+right hemicolectomy+right nephrectomy+right thoracic tumor resection+partial diaphragm resection and repair+abdominal wall tumor resection+inferior vena cava repair+release of extensive abdominal adhesion" for this patient. The surgical procedure was successfully completed for 11 h, and intraoperative bleeding was approximately 900 ml. The tumor, weighing more than 30 kg, was completely resected, and 5 involved organs were also resected. Postoperatively, under attentive treatment and nursing care by Professor Zhang Chun and Attending Physician Liu Sinan from surgical ICU, the patient overcame the challenges of postoperative bleeding and infection, the functional indexes were restored to normal range, the gastrointestinal function was gradually recovered, and he was smoothly discharged. Postoperative pathology confirmed the diagnosis of liposarcoma.
Retroperitoneal tumors usually involve large abdominal vessels and vital organs, and the surgical procedure is extremely demanding. Few hospitals and surgeons can successfully perform such procedures in China. The retroperitoneal tumor at the thoracoabdominal junction is the most complicated surgery in this field. Several issues should be properly handled in this surgery, including how to complete the hilar surgery, rational treatment of large vessels, such as inferior vena cava, and how to avoid severe trauma of combined thoracic and abdominal surgery in such narrow space caused by the huge tumor, etc. The success of combined thoracoabdominal resection of huge retroperitoneal liposarcoma showcases surgical expertise and spirit of MDT complex retroperitoneal tumor team in the hospital, which significantly alleviates the heavy burden upon this patient.
