Dai Niu, Yuan Juzheng, Wang Xiaoyi, Bai He, Ding Haohao, Li Xiao, Yue Shuqiang
Department of General Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China.
Department of General Surgery, The 969th Hospital of the Joint Logistics Support Force of PLA, Hohhot, Inner Mongolia, China.
Am J Case Rep. 2025 Sep 13;26:e948952. doi: 10.12659/AJCR.948952.
BACKGROUND We report a case of a giant (55×35×27 cm, 26 kg) retroperitoneal liposarcoma (RPLS) to provide surgical insights for managing such complex tumors. Due to the potential space in the retroperitoneal cavity, primary retroperitoneal liposarcoma can grow to very large sizes without causing typical symptoms, frequently encasing critical vessels and organs and making resection highly challenging. Most chemotherapy drugs have limited effectiveness against RPLS, while radiotherapy dosages are significantly constrained by toxicity concerns. These limitations underscore why complete surgical resection (R0) continues to be the cornerstone of RPLS treatment and the single most important prognostic factor. While R0 resection remains the primary treatment, innovative approaches are needed to improve outcomes. CASE REPORT A 59-year-old man came for medical treatment due to the continuous growth of an abdominal mass for 2 years. Imaging revealed tumor encasement of the left renal vessels and descending colon, with compression of the aorta and inferior vena cava. Following multidisciplinary evaluation, vascular-oriented resection (VOR) combined with total retroperitoneal lipectomy (TRL) was performed, achieving complete tumor removal along with the involved left kidney and partial colon. Pathology confirmed dedifferentiated liposarcoma (MDM2/CDK4+, Ki-67 10-30%). Postoperatively, the patient showed significant improvement, with resolved lower-limb edema and dyspnea. CONCLUSIONS This case demonstrates the feasibility of VOR combined with TRL for giant retroperitoneal liposarcoma, highlighting the importance of preoperative 3D vascular reconstruction and multidisciplinary collaboration. Although surgical techniques have advanced, the 5-year recurrence rate remains unacceptably high at nearly 50%, highlighting the urgent need to explore more effective adjuvant therapies.
背景 我们报告一例巨大型（55×35×27 cm，26 kg）腹膜后脂肪肉瘤（RPLS）病例，旨在为处理此类复杂肿瘤提供手术方面的见解。由于腹膜后腔存在潜在空间，原发性腹膜后脂肪肉瘤可生长至非常大的尺寸而不引起典型症状，常包绕重要血管和器官，使得切除极具挑战性。大多数化疗药物对RPLS的疗效有限，而放疗剂量因毒性问题受到显著限制。这些局限性凸显了为什么完整手术切除（R0）仍然是RPLS治疗的基石以及唯一最重要的预后因素。虽然R0切除仍然是主要治疗方法，但需要创新方法来改善治疗效果。病例报告 一名59岁男性因腹部肿块持续增大2年前来就医。影像学检查显示肿瘤包绕左肾血管和降结肠，压迫主动脉和下腔静脉。经过多学科评估后，实施了以血管为导向的切除术（VOR）联合全腹膜后脂肪切除术（TRL），完整切除了肿瘤以及受累的左肾和部分结肠。病理证实为去分化脂肪肉瘤（MDM2/CDK4阳性，Ki-67 10%-30%）。术后，患者有显著改善，下肢水肿和呼吸困难消失。结论 本病例证明了VOR联合TRL治疗巨大腹膜后脂肪肉瘤的可行性，突出了术前三维血管重建和多学科协作的重要性。尽管手术技术有所进步，但5年复发率仍高达近50%，令人难以接受，这凸显了迫切需要探索更有效的辅助治疗方法。
