Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
Department of Urology, Yamato Koriyama Hospital, 1-62 Asahii-cho, Yamato Koriyama, Nara, 639-1013, Japan.
World J Surg Oncol. 2019 Feb 18;17(1):35. doi: 10.1186/s12957-019-1581-0.
Retroperitoneal tumors are an uncommon disease known to consist of a diverse group of benign and malignant neoplasms. Treatment of unresectable retroperitoneal lesions requires pathological diagnosis. Here, we report the utility and safety of retroperitoneoscopic biopsy for unresectable retroperitoneal lesions excluding urogenital cancers.
We analyzed 47 patients consisting of 23 (49%) and 24 (51%) cases that underwent retroperitoneoscopic tissue biopsy and open biopsy, respectively. The clinicopathological features, including postoperative complications, were compared between the two groups.
Tumor pathology was diagnosed successfully with a single operation in all patients. Malignant pathology (68%) was more common than benign pathology (32%). The most common pathology was malignant lymphoma, which accounted for about 50% of all cases. There was no significant difference with respect to the age, sex, tumor size, presence of tumor-related symptom, histopathology, operative time, and complications. Three (13%) of 23 patients in the retroperitoneoscopic biopsy group received percutaneous needle biopsy before laparoscopic excisional biopsy because the evaluation of needle cores failed to confirm subclasses of diagnosed pathologies. One patient was converted to open surgery just after the initiation of operation due to severe adhesion of adjacent structures. We had two cases with iatrogenic urinoma due to ureteral injury after retroperitoneoscopic biopsy.
We conclude that retroperitoneoscopic biopsy is a safe and useful tool for benign and malignant retroperitoneal lesions, in comparison to open biopsy. It is critical to carefully examine the preoperative imaging for the location of tumors, especially those close to the renal pelvis and ureter.
腹膜后肿瘤是一种罕见的疾病，由一组良性和恶性肿瘤组成。治疗不可切除的腹膜后病变需要进行病理诊断。在此，我们报告了经腹膜后镜活检在排除泌尿生殖系统癌症的不可切除腹膜后病变中的应用和安全性。
我们分析了 47 例患者，其中 23 例（49%）和 24 例（51%）分别接受了经腹膜后镜组织活检和开放活检。比较了两组患者的临床病理特征，包括术后并发症。
所有患者均成功完成单次手术获得肿瘤病理诊断。恶性病理（68%）比良性病理（32%）更常见。最常见的病理类型是恶性淋巴瘤，占所有病例的 50%左右。两组在年龄、性别、肿瘤大小、肿瘤相关症状、组织病理学、手术时间和并发症方面无显著差异。在经腹膜后镜活检组的 23 例患者中，有 3 例（13%）因针芯评估未能确认诊断病理的亚类，在腹腔镜切除活检前接受了经皮针活检。1 例患者因相邻结构严重粘连，在手术开始后转为开放手术。我们有 2 例经腹膜后镜活检后因输尿管损伤导致医源性尿囊肿。
与开放活检相比，经腹膜后镜活检是一种安全、有效的良性和恶性腹膜后病变的诊断方法。仔细检查术前肿瘤位置的影像学检查至关重要，尤其是靠近肾盂和输尿管的肿瘤。
