A New ROCK Band for Diaphragmatic Reconstruction in Retroperitoneal Sarcoma Surgery.

Abstract

Introduction: Complete surgical resection is the mainstay of treatment for retroperitoneal sarcomas (RPS). For primary well-differentiated liposarcomas and dedifferentiated liposarcomas, aggressive en-bloc resection of adjacent organs is crucial for local control. Diaphragmatic resection may be necessary in left-sided RPS cases. While primary closure of defects is usually possible, large defects may require alternative methods such as prosthetic reconstruction.

Methods: We developed an innovative technique for reconstructing diaphragmatic defects after RPS resection using a rectangular polytetrafluoroethylene band called ROCK band (robust organic composite for kinetic restoration of the diaphragm). This technique involves fixing the folded band to the prevertebral fascia and diaphragm to ensure tension-free closure while preserving diaphragm function. The study analyzed patients treated with this technique at IRCCS-Humanitas Research Hospital from January to December 2023.

Results: Four patients underwent left RPS resection with ROCK band reconstruction. The median age was 56.5 years, with a male/female ratio of 1/3. Median tumor size was 24.5 cm, and median operative time was 409.5 min. There were no ROCK band-related complications, diaphragmatic hernias, or respiratory failures.

Conclusions: This technique provides a safe, effective, and adaptable method for diaphragmatic reconstruction after RPS resection, improving anatomical and functional outcomes. Larger studies are needed for validation.