Combined Laparoscopic and Open Surgical Approach for Well Differentiated Trans-compartmental Liposarcoma Between Pelvic and Femoral Regions.

Background: Soft tissue sarcomas are rare neoplasms, accounting for only 1% of all solid tumors in adults. Liposarcomas represent the most common histological subtype,¹ with aggressive local invasiveness and poor prognosis.² When feasible, resection achieving negative surgical margins remains the only potentially curative treatment.³ Advances in laparoscopic surgical techniques have broadened the indications for minimally invasive oncologic procedures, particularly in cases involving retroperitoneal structures.⁴ 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.^5-9 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.^10,11 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.^12-15 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.

Results: 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.

Conclusions: 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.