Sarcomas, occurring in retroperitoneal space (retroperitoneal sarcomas), are relatively uncommon malignant tumors, composed predominantly of connective tissue, fat or muscle cells, and located in the abdominal posterior wall.
The main types of sarcoma that occur in the retroperitoneum are:
- Liposarcoma – cancer of the fatty tissues
- Leiomyosarcoma – cancer of the involuntary muscle
Less common types of sarcoma in the retroperitoneum include solitary fibrous tumor, pleomorphic sarcoma, malignant nerve sheath tumor, synovial sarcoma and Ewing’s sarcoma.
This disease most commonly occurs among people in their 50s; however, it can occur at any age, affecting men and women alike.
In most cases, these tumors are detected at an advanced stage, when the symptoms have already begun to manifest. Consequently, by the time the tumors are detected, they may have become quite large, and other abdominal tissues may have already been affected. Possible symptoms include abdominal pain, abdominal rigidity, back pain, swelling of lower limbs, intestinal obstruction, and an early feeling of satiation.
There are different treatment options for this disease including surgery, radiation therapy, and chemotherapy.
Surgery is the option with the best possibility of a full recovery, assuming the tumor can be completely removed, however this may not always be possible as the tumor may have spread to nearby organs and tissues.
The aim of the surgery is to remove the tumor completely. In many cases, the tissues of the nearby organs need to be removed as well if the tumor has spread to them. The tumor may have already spread to the bowels, kidneys, adrenal glands, pancreas, liver, spleen, stomach, and diaphragm.
The main criterion for evaluating the potential efficacy of sarcoma surgeries is the ability to remove the tumor with “clear margins,” i.e. when the pathomorphological microscopic study reveals that the resection margin is clear of cancer cells.
A “clear margin” can be achieved in 85% of patients. A considerable number of patients have successful treatment outcomes. Consequently, the 5-year survival rate for this type of disease is in excess of 50%.
Surgery is performed under general anesthesia. The duration of the surgical procedure depends on the size and location of the tumor, and the involvement of the nearby organs and tissues.
The location and size of the incision depends on the actual tumor location. A surgical incision can be made in the center of the abdomen, in the pelvic, or lower back area. It can also involve the lower chest if the tumor is located in the upper abdomen.
Surgical risk factors include infections, bleeding, and damage to peripheral nerves and nearby organs. If the tumor recurs, repeated surgery may be required. The mortality rate for this type of surgery is about 1%. Other potential complications depend on the specific site of the surgery and the need for resection of the affected organs.
Following the Surgery
The length of stay at the hospital after the surgery depends on the extent of the surgical intervention and the individual patient.
After discharge from the
Surgical Oncology Unit , each post-hospital care plan is developed specifically for the patient. In some cases, additional post-operative radiation therapy may be required. The aim of the radiation therapy is to minimize the risk of the tumor recurring.
Following discharge, patients are advised to avoid any strenuous physical activity for about two weeks. Patients return to the hospital for a follow-up visit to remove the stitches/staples usually one week after surgery. It is very important that the patient tell the doctor about any new health issues or concerns which they may have had after the surgery, as well as their general well-being during any consultations.