The interest on partial adrenalectomy has steadily increased over the past twenty years. Adrenal pathologies are mostly benign, making an organ-preserving procedure attractive for many patients. The ...introduction of minimally invasive techniques played probably an important role in this process because they transformed a complex surgical procedure, related to the difficult access to the retroperitoneal space, into a simple operation improving the accessibility to this organ. In this review we summarize the role of partial retroperitoneoscopic adrenalectomy over the years and the current indications and technique.
Purpose
Following radical orchiectomy, surveillance and primary retroperitoneal lymph node dissection (RPLND) are acceptable options for the management of early stage pure testicular teratoma in ...adult patients; however, there is no uniform consensus. The aim of this study was to investigate survival outcomes of adults with early stage pure testicular teratoma based on management strategy.
Methods
Data was extracted from the National Cancer Database (NCDB) from testicular cancer patients diagnosed with clinical stage (CS) I pure teratoma (pT1-4N0M0S0) between 2004 and 2014. Kaplan-Meier and Cox regression analyses were used to assess clinical outcomes based on management strategy.
Results
Of the 61,167 patients diagnosed with testicular cancer, 692 (1.1%) had pure teratoma. Only individuals with CS I disease were considered (
n
= 237). The median age was 28 (23–35) years. Overall, 43 (18%) patients underwent RPLND and 194 (82%) patients were managed with surveillance. There was an increase in surveillance for CS I teratoma during the study period. Increasing distance from residence to treatment facility was an unadjusted predictor for undergoing primary RPLND (
p
< 0.001). Median follow-up was 54 months and there was no significant difference in overall survival between CS I teratoma patients managed with RPLND and those managed with surveillance (
p
= 0.13).
Conclusions
There has been a trend toward increasing adoption of surveillance for the management of early stage pure testicular teratoma in adults. Our findings suggest that surveillance provides comparable survival outcomes to primary retroperitoneal lymph node dissection in this setting.
•Patients in this multi-institutional study had completely endophytic kidney tumors.•This study compares retroperitoneal and transperitoneal robotic partial nephrectomy.•Perioperative and ...postoperative outcomes were similar across study groups.
Retroperitoneal robotic partial nephrectomy (RPN) has been shown to have comparable outcomes to the transperitoneal approach for renal tumors. However, this may not be true for completely endophytic tumors as they pose significant challenges in RPN with increased complication rates. Hence, we sought to compare the safety and feasibility of retroperitoneal RPN to transperitoneal RPN for completely endophytic tumors.
We performed a retrospective analysis of patients who underwent RPN for a completely endophytic renal mass using either transperitoneal or retroperitoneal approach from our multi-institutional database (n = 177). Patients who had a solitary kidney, prior ipsilateral surgery, multiple/bilateral tumors, and horseshoe kidneys were excluded from the analysis. Overall, 156 patients were evaluated (112 71.8% transperitoneal, 44 28.2% retroperitoneal). Baseline characteristics, perioperative and postoperative data were compared between the surgical transperitoneal and retroperitoneal approach using Chi-square test, Fishers exact test, t test, Mood median test and Mann Whitney U test.
Of the 156 patients in this study, 86 (56.9%) were male and the mean (SD) age was 58 (13) years. Baseline characteristics were comparable between the 2 approaches. Compared to transperitoneal approach, retroperitoneal approach had similar ischemia time (19.6 SD = 7.6 minutes vs. 19.5 SD = 10.2 minutes, P = 0.952), operative time (157.5 SD = 44.8 minutes vs. 160.2 SD = 47.3 minutes, P = 0.746), median estimated blood loss (50 ml IQR: 50, 150 vs. 100 ml IQR: 50, 200, P = 0.313), median length of stay (1 IQR: 1, 2 day vs. 1 IQR: 1, 2 day, P = 0.126) and major complication rate (2 4.6% vs. 3 2.7%, P = 0.621). No difference was observed in positive surgical margin rate (P = 0.1.00), delta eGFR (P = 0.797) and de novo chronic kidney disease occurrence (P = 1.000).
Retroperitoneal and transperitoneal RPN yielded similar perioperative and functional outcomes in patients with completely endophytic tumors. In well-selected patients with purely endophytic tumors, either a retroperitoneal or transperitoneal approach could be considered without compromising perioperative and postoperative outcomes.
Despite curative intents of treatment in localized malignant peripheral nerve sheath tumours (MPNSTs), prognosis remains poor. This study investigated survival and prognostic factors for overall ...survival in non-retroperitoneal and retroperitoneal MPNSTs in the Netherlands.
Data were obtained from the Netherlands Cancer Registry and the Dutch Pathology Database. All primary MPNSTs were collected. Paediatric cases (age ≤18 years) and synchronous metastases were excluded from analyses. Separate Cox proportional hazard models were made for retroperitoneal and non-retroperitoneal MPNSTs.
A total of 629 localized adult MPNSTs (35 retroperitoneal cases, 5.5%) were included for analysis. In surgically resected patients (88.1%), radiotherapy and chemotherapy were administered in 44.2% and 6.7%, respectively. In retroperitoneal cases, significantly less radiotherapy and more chemotherapy were applied. In non-retroperitoneal MPNSTs, older age (60+), presence of NF1, size >5 cm, and deep-seated tumours were independently associated with worse survival. In retroperitoneal MPNSTs, male sex and age of 60+ years were independently associated with worse survival. Survival of R1 and that of R0 resections were similar for any location, whereas R2 resections were associated with worse outcomes. Radiotherapy and chemotherapy administrations were not associated with survival.
In localized MPNSTs, risk stratification for survival can be done using several patient- and tumour-specific characteristics. Resectability is the most important predictor for survival in MPNSTs. No difference is present between R1 and R0 resections in both retroperitoneal and non-retroperitoneal MPNSTs. The added value of radiotherapy and chemotherapy is unclear.
•Resectability is the most prognostic factor for survival in localized MPNSTs.•In MPNSTs, NF1, older age, tumour size, and depth are associated with poorer survival.•Retroperitoneal MPNST is a small subgroup with a worse prognosis.•R0 and R1 resections have similar survival in MPNSTs of any location.•The added value of radiotherapy and chemotherapy is unclear for survival in MPNSTs.
Purpose
This study was performed to investigate the effectiveness of hydrodissection during computed tomography-guided renal cryoablation by evaluation of the fluid distribution based on the ...retroperitoneal anatomy with the interfascial plane.
Materials and Methods
Between March 2014 and March 2021, 52 renal tumors were treated by cryoablation with hydrodissection (36 men; mean age 72.5 years). The hydrodissection needle was located in perirenal space. The spreading fluid space based on the retroperitoneal anatomy with the interfascial plane was retrospectively evaluated. The fluid space that most effectively separated the tumor from the adjacent organs was defined. The relationship of the needle tip position in the perirenal space (renal capsule or fascia side) and the most effective fluid space was also evaluated.
Results
Cryoablation was successfully completed in all cases with no major complications. Hydrodissection was effective in all cases. The distance between the tumors and the adjacent organs was significantly longer after hydrodissection (from 7.50 ± 7.43 to 22.6 ± 9.86 mm) (
P
< 0.0001). Although fluid spreading through multiple retroperitoneal spaces was frequently observed, the retromesenteric plane was observed more frequently as the most effective fluid space (67.3%) than the perirenal space (21.2%) (
P
< 0.0001). Regardless of the needle tip position, the most effective fluid space was also commonly the retromesenteric plane.
Conclusions
The retromesenteric plane could be the most effective fluid space to separate the tumor from the adjacent organ, regardless of where the hydrodissection needle tip is positioned in the perirenal space.
Level of Evidence
: 3b.
Graphical Abstract
The aim.
To analyze the results of surgical treatment of sacral schwannomas with their extension into lower pelvis.
Materials and methods
. We analyzed the clinical results of surgical treatment ...of 25 patients with sacral schwannomas, including those with ventral extension and growth into pelvic cavity. All patients were operated at the Clinic of Neurosurgery of the Novosibirsk Research Institute of Traumatology and Orthopedics named after Ya.L. Tsivyan for a 10-year period. The analysis of literature describing prevalence, classification, diagnosis and surgical treatment of sacral tumors and schwannomas in particular was carried out. The features of the course, diagnosis and surgical treatment of sacral schwannomas and accepted surgical methods for their treatment are described.
Results.
The average follow-up period of the patients in our study was 61.6 ± 2 months. Compared with the initial indicators of patients in the postoperative period (1 year after the surgery), a good clinical result with the regression of symptoms was registered in 17 (68 %) out of 25 patients, and 10 (40 %) of them had a significant regression of neurological disorders. 3 (12 %) operated patients had a deterioration of neurological disorders in the form of aggravation of sensitive disorders; one patient had an aggravation of pelvic organ dysfunction. Radical removal of the tumor was achieved in 24 (96 %) out of 25 cases; subtotal resection was performed in 1 (4 %) patient. The number of relapses and continued growth of tumors in our series was 12 % (3 out of 25 patients). The mortality rate was 0 %. The complications were registered in 3 (12 %) cases and manifested as wound liquorrhea in cases of using posterior approach.
Conclusion.
The degree of radicality of tumor resection and clinical outcomes is directly related to the selected surgical approach.
Retroperitoneal echinococcosis (RE) is a rare condition that is associated with a high mortality and disability rate. It is associated with a high rate of misdiagnosis, a high risk of surgery, and is ...extremely difficult to manage. There is no uniform standard for determining the exact form of surgical method and the timing of surgery.This was a retrospective analysis of the characteristics and surgical management of patients diagnosed with RE in our hospital between 2012 and 2019.Between 2012 and 2019, 1257 cases of echinococcosis and 121 cases of RE were diagnosed in our hospital. Of these, 68 cases involved surgical treatment, 53 involved non-surgical treatment, and 12 cases were lost to follow-up (4 cases in the surgical group and 8 cases in the non-surgical group). Thus, 109 cases were followed-up. RE cases were divided according to different treatment methods into a radical resection group (Group A, 31 cases), a non-radical resection group (Group B, 37 cases), and a non-surgical group (Group C, 53 cases). We carried out a detailed analysis of the 109 cases experiencing surgical intervention with effective follow-up.Our analysis found that radical resection is the first line of treatment of RE, although non-radical surgery can benefit most patients. It is important to emphasize the importance of the first round of surgery, particularly in cases involving hepatic echinococcosis. If the lesion can be removed radically during the first round of surgery, then radical surgery should be performed.
Background IgG4 -related disease (IgG4 -RD) is a systemic condition of unknown cause characterized by highly fibrotic lesions with dense lymphoplasmacytic infiltrates. CD4+ T cells constitute the ...major inflammatory cell population in IgG4 -RD lesions. Objective We used an unbiased approach to characterize CD4+ T-cell subsets in patients with IgG4 -RD based on their clonal expansion and ability to infiltrate affected tissue sites. Methods We used flow cytometry to identify CD4+ effector/memory T cells in a cohort of 101 patients with IgG4 -RD. These expanded cells were characterized by means of gene expression analysis and flow cytometry. Next-generation sequencing of the T-cell receptor β chain gene was performed on CD4+ SLAMF7+ cytotoxic T lymphocytes (CTLs) and CD4+ GATA3+ TH 2 cells in a subset of patients to identify their clonality. Tissue infiltration by specific T cells was examined by using quantitative multicolor imaging. Results CD4+ effector/memory T cells with a cytolytic phenotype were expanded in patients with IgG4 -RD. Next-generation sequencing revealed prominent clonal expansions of these CD4+ CTLs but not CD4+ GATA3+ memory TH 2 cells in patients with IgG4 -RD. The dominant T cells infiltrating a range of inflamed IgG4 -RD tissue sites were clonally expanded CD4+ CTLs that expressed SLAMF7, granzyme A, IL-1β, and TGF-β1. Clinical remission induced by rituximab-mediated B-cell depletion was associated with a reduction in numbers of disease-associated CD4+ CTLs. Conclusions IgG4 -RD is prominently linked to clonally expanded IL-1β– and TGF-β1–secreting CD4+ CTLs in both peripheral blood and inflammatory tissue lesions. These active, terminally differentiated, cytokine-secreting effector CD4+ T cells are now linked to a human disease characterized by chronic inflammation and fibrosis.
Atypical spindle cell lipomatous tumor (ASLT) is a rare soft tissue neoplasm with a low potential for malignancy. ASLT frequently occurs in the limb and limb girdles. However, large retroperitoneal ...ASLTs are extremely rare. There was no concrete case report of retroperitoneal ASLTs.
An 18-year-old woman presented with abdominal pain and a palpable mass. Abdominal computed tomography revealed a large fatty mass that was approximately 30 cm in size and filled the entire abdominal cavity. Surgical excision was indicated. The tumor did not invade the adjacent organs. The pelvic cavity was then too narrow to dissect smoothly. The mass was successfully excised without tumor rupture or adjacent organ injury. Microscopically, the neoplasm was a well-differentiated adipocytic neoplasm. Immunohistochemical staining showed that the spindle cells were positive for CD34 and desmin, in addition to multifocal positivity for S100 protein. These histological features were consistent with an ASLT. The patient's postoperative course was uneventful. At the 12-mo follow-up, no evidence of recurrence or metastasis was observed.
To the best of our knowledge, our study is the first concrete report of a large retroperitoneal ASLT in the English literature. In the large retroperitoneal ASLT located in the pelvic cavity, which made it too narrow and tight to dissect, complete excision is difficult but very important because of recurrence risk. Although large retroperitoneal ASLTs are considered extremely rare, their detection is important for accurate evaluation and management. Owing to their significant rarity, retrospective multicenter case studies are required to determine the clinicopathologic characteristics.
Post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND) is an integral part of the management of patients with metastatic non-seminoma and residual masses >1 cm after chemotherapy.
To ...assess perioperative complications and oncological outcomes at two major referral centres in Switzerland.
This was a retrospective chart review of 136 patients with non-seminoma who underwent PC-RPLND between 2010 and 2020 at the university hospitals of Bern and Zürich. Patient, treatment and tumour characteristics as well as the types and frequencies of intra- and postoperative complications were registered and compared using the chi-square test. Oncological outcomes consisted of the time and location of relapses as well as progression-free and overall survival, which were compared using the log-rank test.
Overall, 70 patients from Bern and 66 patients from Zürich were included; 5 patients had a previous retroperitoneal lymph node dissection (RPLND) (2 Bern, 3 Zürich). Vascular injuries were the most frequent intraoperative complication, occurring in 27/136 (19.9%) patients. Postoperative complications were observed in 42/136 (30.9%) patients, ileus being the most common. Perioperative mortality was 2.2%. A retroperitoneal mass ≥50 mm was significantly associated with intraoperative complications (p = 0.004) and increased resource demands (p = 0.021). Postoperative morbidity was higher according to age at post-chemotherapy retroperitoneal lymph node dissection ≥40 years (p = 0.028) and retroperitoneal mass ≥20 mm (p = 0.005). The median follow-up time was 37 months (interquartile range IQR 18-64 months). The median progression-free survival at 5 years was 76% (95% confidence interval CI: 64-85%) in Bern and 69% (95% CI: 54-80%) in Zürich (p = 0.464). The median overall survival at 5 years was 88% (95% CI: 76-94%) in Bern and 77% (95% CI: 60-87%) in Zürich (p = 0.335). Patients with progressive disease or a tumour marker increase before retroperitoneal lymph node dissection had significantly inferior progression-free and overall survival compared to non-progressing patients. The presence of teratoma in resected specimens did not confer inferior survival probabilities compared to necrosis only, whereas the presence of vital undifferentiated tumour conferred inferior progression-free and overall survival. Patients with a previous retroperitoneal lymph node dissection and patients operated for late relapses >2 years after chemotherapy also had significantly inferior progression-free and overall survival.
We found a relevant rate of severe perioperative complications at PC-RPLND at even experienced high-volume centres. The oncological outcomes at two major university urological centres in Switzerland were similar and determined by preoperative risk factors and intraoperative histology.
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