Belly getting bigger is not necessarily pure gain fat!It could also be retroperitoneal liposarcoma

2022-08-05 0 By

Recently, Associate Professor Li Feng and his team successfully performed the first retroperitoneal total fat resection for a patient with huge retroperitoneal tumor in Qilu Hospital. The patient recovered well after surgery and has been discharged from hospital.This was the first case of retroperitoneal total fat resection in our hospital, and the therapeutic effect was satisfactory.Patient sun uncle suffers abdominal distension, suffocating torture for a long time, stomach is bigger and bigger, across the belly can feel a “big package”, this “big package” the sun uncle “STH STH over and over” is not light, the symptom of abdominal distension is more and more heavy, not only eat, even breathing has been affected.The patient went to and from many hospitals, considering the complex condition, the difficulty of surgery, dare not receive treatment.The patient was admitted to the third ward of qilu Hospital by Li Feng.Further examination revealed that there was a huge tumor in the abdominal cavity, about 35×25×10cm in size, occupying more than half of the abdominal cavity. The tumor originated from the retroperitoneum, was closely related to inferior vena cava, reproductive vessels, ureter, and right renal vessels, and surrounded the right adrenal gland and perirenal fat sac.The patient developed obvious hydronephrosis and digestive tract compression due to the tumor squeezing the intestine, kidneys, and ureters.The case was diagnosed as retroperitoneal liposarcoma after careful analysis by Li Feng’s team after comprehensive preoperative evaluation and multidisciplinary discussion.The tumor is huge, the adjacent relationship is complex, and the operation is extremely difficult. How to properly protect the great abdominal vessels and whether to preserve the right kidney are two major problems in the operation.Preoperative repeatedly research, formulate the detailed operation program and back-up plans (excision of inferior vena cava reconstruction, artificial vascular anastomosis or bypass, as well as combined resection of kidney), at the same time, badad also take into account the characteristics of retroperitoneal liposarcoma postoperative relapse easily, on the basis of complete tumor resection, should also be retroperitoneal fat removal, namely complete resection of the tumor root cause,Strive to achieve the best therapeutic effect, so that patients benefit the most.The tumor had brought severe compression symptoms to the patient, and surgical treatment was urgent. After active and complete preoperative preparation, under the guidance of Professor Wang Lei, Associate Professor Li Feng, Associate Professor Xu Jianwei and attending physician Liu Han successfully performed retroperitoneal giant tumor resection and retroperitoneal total fat resection for the patient.Although the tumor was closely related to the right kidney and its blood vessels, the right kidney was preserved and hydrone was significantly relieved under the careful operation of Li Feng’s team.Under the close cooperation of anesthesia and nursing team, the operation only took 3 hours and 200ml of intraoperative bleeding.Postoperative pathology confirmed the highly differentiated liposarcoma.After the operation, Li feng’s team applied ERAS ERAS ‘concept of rapid recovery in combination with the patient’s specific situation. After receiving early enteral nutrition, early activity, basic analgesia and other treatments, the patient was put on a fluid diet on the first day after the operation.FIG. 1: Large retroperitoneal tumor (yellow transparent area) extruding the abdominal organs, closely related to the great vessels in the abdominal cavity.Malignant tumors account for 80% of retroperitoneal tumors, most commonly mesenchymal sarcomas.Retroperitoneal tumors have few incidence, complex pathological types and high difficulty in treatment. Surgical resection is the main treatment method at present, and it is the best means for patients to obtain a potential cure.The high postoperative recurrence rate is the main reason for the poor prognosis of retroperitoneal sarcoma, li said. Postoperative recurrence of retroperitoneal liposarcoma is not only related to the pathological subtype and histological grade of the tumor, but also related to the completeness and scope of tumor resection.The multiple growth and recurrence of retroperitoneal liposarcoma determine that retroperitoneal total fat resection is the most reasonable surgical method to reduce the risk of tumor residue and recurrence. However, retroperitoneal total fat resection is difficult and requires high technical requirements, which puts forward higher requirements for the operator.Due to the particularity of retroperitoneal tumor in biological characteristics, pathological types and other aspects, the role of multidisciplinary collaboration is particularly important. Patients with retroperitoneal tumor must go to a large experienced diagnosis and treatment center for standardized treatment to improve the treatment effect.(Correspondent Wu Dong)