Devascularization of the superior mesenteric vein without reconstruction during surgery for retroperitoneal liposarcoma: A case report and review of literature

Abstract

A 61-year-old female patient with chronic hepatitis B virus infection was diagnosed with liposarcoma in a community hospital. Fine needle aspiration biopsy confirmed the diagnosis of well-differentiated liposarcoma. Abdominal computed tomographic angiography (CTA) showed that the mass adhered to and constricted the main trunk and branch of the superior mesenteric vein (SMV), especially the ileocolic vein, and collateral circulation was observed during the vascular reconstruction scan. The abdominal liposarcoma was resected. Because of the collateral circulation, devascularization of the SMV was attempted, and we resected the eroded SMV. The condition of the blood vessels was evaluated 20 d after surgery using CTA, which showed that the SMV had disappeared. Significant improvements in SMV collateral circulation and the inferior mesenteric vein were observed after vascular reconstruction. The patient had an uneventful postoperative course except for transient gastroplegia. Twenty months after surgery, the patient had a recurrence of liposarcoma. She underwent tumor resection to remove the distal small intestine and right hemicolon. We learned that (1) direct devascularization of the main SMV trunk without a vein graft is possible. The presence of collateral circulation can increase the success rate of patients undergoing radical surgery and prevent the occurrence of serious postoperative complications. In addition, (2) this case demonstrated the clinical value of 3D reconstruction.

Laparoscopic approach to an incidentally found pelvic retroperitoneal liposarcoma

“…We reviewed the literature concerning on retroperitoneal WDLPS in women using PubMed until August 2018, using the following key words “well-differentiated liposarcoma,” “retroperitoneal well-differentiated liposarcoma,” “well-differentiated liposarcoma of retroperitoneum,” “atypical lipomatous tumor,” “retroperitoneal atypical lipomatous tumor,” “atypical lipomatous tumor of retroperitoneum.” A total of 36 retroperitoneal WDLPS were found; in 4 cases, few data were reported, so 32 cases were included in the review. [2,7–35]…”

“…The most common surgical approach was laparotomy, as minimally invasive surgery was chosen in only 3 cases (9.4%). [14,27,35] WDLPS was completely excised without multiorgan resection in 23/32 (71.9%) patients, [2,8,9,11,12,14,16,20–23,25–32,34,35] in 9/32 (28.1%) patients required a more aggressive surgery. [8,10,13,15–19,24,33] Postsurgical treatment was reported in 28/32 (87.5%) patients: 23/28 (82.1%) patients received no adjuvant therapy, 2/28 (7.1%) patients received chemotherapy, [8,10] 2/28 (7.1%) patients received radiation therapy, [12,13] and 1/28 (3.6%) patient received both chemo and radiotherapy.…”

“…[8] One patient of 7 (14.3%) had 1 recurrence that was treated with surgery and chemotherapy, she was FOD at 8 months from relapse. [31] Four patients of 7 (57.1%) had 1 recurrence that was surgically treated, 1 patient recurred after 16 months, [29] 1 after 20 months, [2] 1 after 35 months, [16] and 1 after 84 months. [23] After surgery 3 patients remained FOD [2,16,29] while we did not find follow-up information about 1 patient.…”

“…[31] Four patients of 7 (57.1%) had 1 recurrence that was surgically treated, 1 patient recurred after 16 months, [29] 1 after 20 months, [2] 1 after 35 months, [16] and 1 after 84 months. [23] After surgery 3 patients remained FOD [2,16,29] while we did not find follow-up information about 1 patient. [23] Survival information were available for 27/32 (84.4%) patients, 26/27 (96.3%) patients were FOD and 1/27 (3.7%) patient died with disease (DWD) 84 months after diagnosis.…”

“…Liposarcoma (also known as atypical lipomatous tumor [1] ) is the most common soft-tissue tumor. It is a rare malignant tumor of embryogenic mesodermal origin presenting in the following histologic variants: well-differentiated, myxoid, round cell, pleomorphic, and dedifferentiated [2] ).…”