Department of General-, Visceral-, Thoracic- and Vascular Surgery, Kliniken Frankfurt-Main-Taunus, Bad Soden Am Taunus, Germany.
Kelkheim Health Care Center, Kelkheim, Germany.
Acta Chir Belg. 2020 Apr;120(2):79-84. doi: 10.1080/00015458.2019.1689645. Epub 2019 Nov 12.
Liposarcomas found incidentally during open or laparoscopic inguinal hernia surgery are extremely rare. It is unclear, whether any adipose tissue being removed during inguinal hernia surgery must be sent for histology due to the potential risk of liposarcoma of the spermatic cord. This study aims to evaluate the frequency of liposarcomas incidentally found in the inguinal canal during hernia surgery and tries to derive evidence-based recommendations regarding the optimal management of any fatty tissue found in the inguinal canal. A literature review of the PubMed/Medline electronic databases between January 1980 and January 2019 was performed using the search terms 'inguinal hernia' and 'liposarcoma'. There was only one study available on this topic. Therefore, an additional literature review was performed analyzing all reports on patients with incidentally detected liposarcomas of the spermatic cord in the inguinal canal during hernia surgery. There was only one retrospective study evaluating the frequency of inguinal liposarcoma found at hernia operations with a frequency of less than 0.1%. There were 18 cases of spermatic cord liposarcomas that were truly found incidentally during operation for an unsuspected symptomatic or incarcerated inguinal hernia. These included 16 case reports with a total of 18 patients and 19 liposarcomas. All patients were male with a median age of 62.5 years (range: 24-86 years) years. Median size of liposarcoma was 10.5 cm (range: 3-30 cm). In seven patients, the inguinal liposarcoma was an extension of a retroperitoneal sarcoma. Treatment consisted of radical orchidectomy during the primary operation in 12 patients. Three out of the seven patients with retroperitoneal extension of the tumor underwent a secondary operation with complete resection of the tumor. Currently, there is no evidence-based recommendation available regarding the management of lipomas detected during open or laparoscopic inguinal hernia surgery. Due to the extremely low risk of the presence of a liposarcoma, routine histologic examination cannot be recommended unless the diameter exceeds 10 cm.
在开放式或腹腔镜腹股沟疝手术中偶然发现的脂肪肉瘤极为罕见。目前尚不清楚，在腹股沟疝手术中，由于精索脂肪肉瘤的潜在风险，是否必须将切除的任何脂肪组织送检组织学检查。本研究旨在评估在疝手术中偶然发现的腹股沟管内脂肪肉瘤的频率，并尝试针对在腹股沟管内发现的任何脂肪组织的最佳处理方法提供循证推荐。使用“腹股沟疝”和“脂肪肉瘤”这两个检索词，对 1980 年 1 月至 2019 年 1 月期间的 PubMed/Medline 电子数据库进行了文献回顾。关于这个主题只有一项研究。因此，还进行了额外的文献回顾，分析了所有关于在疝手术中偶然发现的精索内脂肪肉瘤的报告。只有一项回顾性研究评估了在疝手术中偶然发现的腹股沟脂肪肉瘤的频率，其频率低于 0.1%。有 18 例精索脂肪肉瘤是在因可疑症状性或嵌顿性腹股沟疝而进行的手术中偶然发现的。其中包括 16 例病例报告，共 18 例患者和 19 例脂肪肉瘤。所有患者均为男性，中位年龄为 62.5 岁（范围：24-86 岁）。脂肪肉瘤的中位大小为 10.5cm（范围：3-30cm）。在 7 例患者中，腹股沟脂肪肉瘤是腹膜后肉瘤的延伸。在 12 例患者中，在初次手术时进行了根治性睾丸切除术。在 7 例肿瘤腹膜后延伸的患者中有 3 例接受了二次手术，完全切除了肿瘤。目前，对于开放式或腹腔镜腹股沟疝手术中发现的脂肪瘤，尚无基于证据的处理推荐。由于存在脂肪肉瘤的风险极低，除非直径超过 10cm，否则不能推荐常规进行组织学检查。
