Laparoscopic resection of a left retroperitoneal solitary fibrous tumor

Abstract

Introduction

Retroperitoneal sarcomas (RPS) are rare tumors, comprising 15 % of all soft tissue sarcomas (STS). Surgery remains the cornerstone of treatment for localized RPS and is tailored to histologic type.¹ In liposarcoma, the most common RPS, en-bloc resection of the tumor with adjacent organs (such as the colon, kidney, and psoas muscle) is performed to ensure complete clearance of ipsilateral retroperitoneal fat and minimize the risk of local recurrence. Conversely, solitary fibrous tumors (SFT) have a lower risk of local recurrence, and adjacent organs are resected only if invaded.2, 3 Minimally invasive surgery (MIS) may be considered for select patients with SFT at specialized sarcoma centers.⁴

Video

This video presents a 67-year-old man with a 9 cm left retroperitoneal SFT treated with preoperative radiotherapy. The patient underwent laparoscopic en-bloc resection, including a marginal portion of the ipsilateral psoas and quadratus lumborum muscles, perirenal fat, and gonadal vessels, while the ipsilateral kidney, ureter, and femoral nerve were preserved.

Results

Following multidisciplinary discussion, and considering histologic type, preoperative radiotherapy, and initial imaging, complete en-bloc resection was achieved with a kidney-sparing procedure, resulting in negative microscopic margins. Oncological surgical principles for STS were upheld, with dissection performed outside anatomical planes to ensure clear margins. Postoperative recovery was uneventful, and the patient was discharged home on postoperative day 4. The patient is alive and disease-free one year after surgery.

Conclusions

This video demonstrates the feasibility and safety of MIS for select patients with retroperitoneal SFT treated at sarcoma referral centers, emphasizing adherence to oncological surgical principles.