Thoracoabdominal Approach for Retroperitoneal Liposarcoma Involving the Diaphragm : A Case Report

Abstract

An 81-year-old man presented to our hospital with left lower back pain. The computed tomographic scan revealed a retroperitoneal tumor with a heterogeneous contrast effect. Magnetic resonance imaging scan showed that the tumor was suspected to have invaded the left diaphragm, iliopsoas muscle, and pancreas, and an unclear boundary between the tumor and left kidney. Based on these findings, a left retroperitoneal sarcoma or renal carcinoma was suspected. A left retroperitoneal tumor resection, combined with left nephrectomy, was performed. A thoracoabdominal approach was chosen due to suspected diaphragmatic invasion and the need for an adequate operative field on the cephalic side of the kidney. The tumor was resected along with the left kidney, a portion of the diaphragm, and a portion of the iliopsoas muscle, without pancreatic resection. Pathological examination confirmed a dedifferentiated liposarcoma. No intraoperative or postoperative complications were encountered. Surgical resection with a negative surgical margin is crucial for the treatment of retroperitoneal liposarcoma. The thoracoabdominal approach provides excellent surgical exposure and allows for early vascular control. Although the thoracoabdominal approach is rarely used in urological surgery due to concern about the morbidity associated with violating the thoracic cavity, it can be performed effectively and safely for large or invasive retroperitoneal tumors in select cases requiring maximal surgical resection