Retroperitoneal Tumor Surgery

Biopsy and tests before surgery

• CT of the abdomen, pelvis and chest with contrast — size, relationship to organs and vessels, metastases; MRI — for pelvic tumors;
• percutaneous core needle biopsy under CT or ultrasound guidance — preferably via a retroperitoneal route if technically feasible, not through the abdominal cavity; if paraganglioma is suspected, its hormonal activity is assessed first, and whether a biopsy is needed and safe is decided separately by the tumor board;
• review of the biopsy by a pathologist who specializes in sarcomas, with immunohistochemistry and molecular tests;
• assessment of the function of each kidney separately — in case the kidney may have to be removed together with the tumor.

Open or laparoscopic biopsy is avoided when a retroperitoneal sarcoma is suspected, because of the risk of spreading tumor cells and complicating subsequent surgery. Not all retroperitoneal tumors are sarcomas: there are schwannomas, desmoids and paragangliomas with varying metastatic potential. A biopsy is usually needed to establish the tumor type; exceptions are decided by an expert tumor board. About tumor types — on the page “Retroperitoneal Sarcomas”.

When surgery is possible

Surgery is recommended when the tumor can be removed completely and there are no distant metastases that determine the approach. Even a large tumor lying against several organs is often operable: neighboring organs are removed together with it if needed.

In selected cases, mainly at an expert center or within a clinical trial, chemotherapy or radiation therapy before surgery is discussed — they are not a standard. For most patients surgery is performed as the first step.

For pelvic tumors — extravisceral sarcomas, desmoids, schwannomas — the plan is drawn up especially carefully: sometimes removal of part of the bowel or bladder, or reconstruction of the ureter or vessels, is needed. Benign tumors, on the contrary, can often be removed while preserving the organs, and desmoids are often observed first.

If surgery is not possible right now

With distant metastases or a tumor that cannot be removed completely, chemotherapy is the basis of treatment; targeted drugs are available for certain types. For well-differentiated liposarcoma, which grows slowly, observation is sometimes chosen.

For recurrence, which is not uncommon in liposarcoma, a repeat operation is possible in patients whose tumor came back late and can again be removed completely. If the tumor has already been “shelled out” elsewhere, the operative report, a pathology review and a repeat CT are needed — a surgeon’s second opinion is suitable for this.

How the operation is performed

The tumor is removed en bloc together with the surrounding tissue without opening it — if needed, with the kidney, a segment of bowel, part of a muscle, the pancreas or the spleen. The goal is to remove the tumor completely, without rupturing it, where possible with a layer of tissue around it, because this is what reduces the risk of recurrence. “Shelling out” the tumor from its capsule, even if it seems technically simpler, increases the risk of rupture and of leaving tumor cells behind.

If the tumor involves a major vein, the vein is removed and reconstructed if needed. As a standard, the operation is performed open — because of the tumor size and the extent of resection.

Hospital stay, recovery and follow-up

Recovery follows the enhanced recovery (ERAS) protocol: early mobilization, early eating, controlled pain relief. How long recovery takes depends on which organs were removed: after kidney removal the function of the other kidney is monitored, after bowel resection — nutrition.

After complete removal, adjuvant treatment is usually not needed; exceptions are considered by the tumor board based on tumor type and grade. Follow-up is long-term: CT of the abdomen and chest every 3–6 months in the first years, then less often but for years, because recurrences, especially of liposarcoma, can appear late.

Risks and complications

Risks are what patients ask about least often, although they are the most important thing to discuss before surgery. The main ones are:

• bleeding — especially when the tumor is close to major vessels;
• consequences of organ removal — reduced kidney function after nephrectomy, anastomotic leak after bowel resection;
• injury to nerves and ureters with pelvic tumors;
• infection and general surgical complications, including thrombosis.

The likelihood of each depends on the size of the tumor, which organs are removed, and your general condition. I will explain the risks in your particular case at the consultation.

What the cost depends on

The cost depends on the extent of the operation — which organs are removed together with the tumor and whether vascular reconstruction is needed — the number of days in the hospital and the tests, including biopsy and pathology review. The exact amount is named once the treatment plan has been defined. The payment can be split into parts — installments are available. The in-person consultation is free. More details are on the page “Cost of Surgery: What It Depends On”.

What documents are needed and how to book

• CT or MRI discs with reports — the discs themselves;
• the biopsy report, tissue blocks and slides — for review by a pathologist who specializes in sarcomas;
• the operative report and pathology, if the tumor has already been removed;
• blood tests with creatinine, kidney function data;
• summaries of previous treatment.

Book a consultation by phone or through the form. If you are from another city, send the documents in advance — how to do this is described on the page “Online Oncologist Consultation”.