Aulicino Matteo, D'Annibale Giorgio, Orsini Cecilia, Barberis Lorenzo, Partipilo Tommaso, Santullo Francesco, Di Giorgio Andrea, Abatini Carlo, Attalla El Halabieh Miriam, Ferracci Federica, Pacelli Fabio, Lodoli Claudio
General Surgery Department, Università Cattolica del Sacro Cuore, Rome, Italy.
Surgical Unit of Peritoneum and Retroperitoneum Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Ann Surg Oncol. 2025 Oct;32(10):7834-7835. doi: 10.1245/s10434-025-17553-w. Epub 2025 Jun 3.
Soft tissue sarcomas are rare neoplasms, accounting for only 1% of all solid tumors in adults. Liposarcomas represent the most common histological subtype, with aggressive local invasiveness and poor prognosis. When feasible, resection achieving negative surgical margins remains the only potentially curative treatment. Advances in laparoscopic surgical techniques have broadened the indications for minimally invasive oncologic procedures, particularly in cases involving retroperitoneal structures. These developments support the consideration of laparoscopy in selected retroperitoneal tumors as well. However, the minimally invasive approach to retroperitoneal sarcomas remains unconventional and is mostly described in case reports and small series. Moreover, a significant technical and oncological challenge is posed by well differentiated "trans-compartmental" liposarcoma which originate in one anatomical region and extend into adjacent districts through anatomical foramina. Frequently these tumors originate from the pelvic region and extend outside the retroperitoneal space trough the abdominal wall into the inguinal or crural spaces, simulating hernias. METHODS: In this video, we present the case of a 62 years old patient with a well differentiated liposarcoma originating from the right pelvic region and extending along the iliofemoral axis into the right femoral area.
The video demonstrates a step-by-step approach to oncological surgery through a combined laparoscopic and inguinal approach, identifying critical anatomical landmarks and outlining the rationale guiding the reconstructive phase.
Minimally invasive surgical management of soft tissue sarcomas is technically feasible in tertiary referral centers with advanced expertise in laparoscopic surgery. Optimal oncological outcomes are achievable by integrating different surgical approaches, emphasizing the relevance of a tailored strategy.
软组织肉瘤是罕见肿瘤，仅占成人所有实体瘤的1%。脂肪肉瘤是最常见的组织学亚型，具有侵袭性局部浸润和预后不良的特点。在可行的情况下，实现手术切缘阴性的切除仍然是唯一可能治愈的治疗方法。腹腔镜手术技术的进步拓宽了微创肿瘤手术的适应证，特别是在涉及腹膜后结构的病例中。这些进展也支持在某些腹膜后肿瘤中考虑采用腹腔镜手术。然而，腹膜后肉瘤的微创方法仍然不常见，大多在病例报告和小系列研究中有所描述。此外，高分化的“跨区域”脂肪肉瘤带来了重大的技术和肿瘤学挑战，这种肿瘤起源于一个解剖区域，并通过解剖孔延伸到相邻区域。这些肿瘤通常起源于盆腔区域，通过腹壁延伸到腹膜后间隙之外，进入腹股沟或股部间隙，类似疝气。
在本视频中，我们展示了一名62岁患者的病例，该患者患有高分化脂肪肉瘤，起源于右盆腔区域，并沿髂股轴延伸至右股部区域。
该视频展示了通过腹腔镜和腹股沟联合入路进行肿瘤手术的逐步方法，识别关键解剖标志，并概述指导重建阶段的基本原理。
在具备先进腹腔镜手术专业知识的三级转诊中心，软组织肉瘤的微创外科治疗在技术上是可行的。通过整合不同的手术方法可以实现最佳肿瘤学结果，强调了量身定制策略的相关性。
