Laparoscopic Resection of Nonadrenal Retroperitoneal Tumors

Background: Laparoscopic resection of primary retroperitoneal tumors is a challenging procedure because access is difficult due to the deep, posterior location and adjacent major vessels.

Objective: To assess the safety and feasibility of laparoscopic resection of primary nonadrenal retroperitoneal tumors. Method  Data on 20 patients with a diagnosis of primary retroperitoneal tumor who underwent laparoscopic resection from August 1, 2003, to June 30, 2009 were analyzed.

Results: Twenty patients (12 men and 8 women; median age, 45.5 years) were included in the review. The tumor sizes ranged from 2.0 to 9.5 cm in diameter (median, 4.7 cm). In 10 patients, tumors were adherent to adjacent major vessels (ie, inferior vena cava, renal vein, superior mesenteric vein, or the splenic vessel). Postoperative examination of the samples revealed that lymphangioma (7 [35.0%]) was the most common tumor type, followed by ganglioneuroma (3 [15.0%]), schwannoma (2 [10.0%]), paragangolioma (2 [10.0%]), and Castleman disease (2 [10.0%]). The median operative time was 117.5 minutes and the median estimated blood loss was 50.0 mL. One operation (0.05%) was converted to laparotomy due to intraoperative bleeding. Postoperative complications occurred in 2 patients (10.0%), both of whom were treated conservatively. The median length of the postoperative hospital stay was 5 days. Neither tumor size nor the presence of adhesions to adjacent vessels affected the perioperative or clinical outcomes.

Conclusion: Laparoscopic resection of retroperitoneal tumors is feasible even when a tumor is large or adheres to adjacent vascular structures if there is no evidence of malignancy based on preoperative radiologic studies.