Baia M, Dossa F, Radaelli S, Callegaro D, Colombo C, Borghi A, Pasquali S, Morosi C, Sangalli C, Sanfilippo R, Fiore M, Gronchi A
Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
Ann Surg Oncol. 2025 Jul 2. doi: 10.1245/s10434-025-17739-2.
Surgery at high-volume centers remains the cornerstone of retroperitoneal sarcoma (RPS) treatment, requiring en bloc resection of the tumor with adjacent organs when appropriate. This video illustrates a standardized six-stage surgical approach for primary left-sided retroperitoneal liposarcoma, modeled on the same concept of the six-stage technique previously described for right retroperitoneal liposarcoma. PATIENT AND METHODS: A 73-year-old man presented with a 13-cm primary left retroperitoneal high-grade dedifferentiated liposarcoma. The tumor displaced the descending colon and abutted the pancreatic tail and psoas muscle. Following Tumor-Board evaluation, the patient received preoperative chemotherapy (three cycles of epirubicin-ifosfamide), resulting in disease stability upon restaging.
The patient underwent en bloc resection of the left retroperitoneal mass, including the ipsilateral kidney, adrenal gland, and colon. A healthy plane was identified between the tumor and the pancreatic tail. Given the patient's age, prior chemotherapy, and high-risk of pancreatic fistula, the distal pancreas and spleen were dissected free and preserved. On the posterior side, the psoas muscle was tightly adherent to the tumor and was resected to ensure oncological adequacy. This structured medial-to-lateral approach allows early vascular control and safe identification of critical structures.
Resecting a left RPS is a complex procedure that demands a diverse set of surgical skills. This six-stage approach, developed over two decades in a high-volume center, provides a reproducible and oncologically sound benchmark, applicable virtually in all cases while ensuring a resection adherent to the principles of surgical oncology.
在高容量中心进行手术仍然是腹膜后肉瘤（RPS）治疗的基石，必要时需要将肿瘤与相邻器官整块切除。本视频展示了一种针对原发性左侧腹膜后脂肪肉瘤的标准化六阶段手术方法，该方法基于先前描述的右侧腹膜后脂肪肉瘤六阶段技术的相同概念。
一名73岁男性，患有一个13厘米的原发性左侧腹膜后高级别去分化脂肪肉瘤。肿瘤推移了降结肠，并紧邻胰尾和腰大肌。经过多学科肿瘤讨论评估后，患者接受了术前化疗（三个周期的表柔比星-异环磷酰胺），重新分期时病情稳定。
患者接受了左侧腹膜后肿块的整块切除，包括同侧肾脏、肾上腺和结肠。在肿瘤与胰尾之间发现了一个健康平面。鉴于患者的年龄、先前的化疗以及胰瘘的高风险，游离并保留了胰腺远端和脾脏。在后方，腰大肌与肿瘤紧密粘连，予以切除以确保肿瘤切除的彻底性。这种从内侧到外侧的结构化方法允许早期控制血管并安全识别关键结构。
切除左侧腹膜后肉瘤是一个复杂的手术过程，需要多种手术技能。这种在高容量中心经过二十多年发展而来的六阶段方法提供了一个可重复且肿瘤学上合理的基准，几乎适用于所有病例，同时确保切除符合外科肿瘤学原则。
