Page 4 - World Journal of Laparoscopic Surgery

Matvey Tsivian et al
articles in english were reviewed and summarized collecting injury was identified and repaired intraoperatively; postoperative
available data as reported for our series. course was uneventful in all cases.
Final pathology was local recurrence of Renal cell carcinoma
RESULTS (RCC) in 3 cases, 1 lymphoma, 1 sarcoma, 1 schwannoma and
2 retroperitoneal cysts (one of adrenal origin). It is of note that
Table 1 summarizes clinical presentation, imaging findings and in our series malignant pathology accounted for 5 out of 8 cases
demographics of the patients in our series. (62.5%).
Of note, in our series 3 cases (37.5%) were found on follow-
Hospital stay ranged from 2 to 7 days (median 3). With an
up imaging due to history of RCC. It is important to note that average follow-up of over 2 years there are no recurrences.
only 3 of 8 patients were symptomatic at presentation. Average Patient no. 1 was lost on follow-up after 24 months.
lesion size (largest diameter on imaging) was 6.88 cm ranging
from 2 to 16 cm.
Surgery and postoperative course are reported in Table 2. DISCUSSION
In 2 (25%) cases preoperative biopsy was performed and only Literature review yielded 21 papers of laparoscopic treatment
in one case its result correlated with final pathology diagnosis. of retroperitoneal masses for a total of 27 cases. Most papers
Only in one case incisional biopsy was performed whether all are case reports 1-18 and there are 3 small series. 19-21 Table 3
other findings were radically excised. All procedures were summarizes the data of those cases; unfortunately some papers
successfully completed laparoscopically with no conversions. are incomplete with regards to several data elements. As for
Mean operative time was 131 min (range 60-270 minutes), in two today, to the best of our knowledge, this is the largest series of
cases concomitant surgery was performed (laparoscopic ventral laparoscopic treatment of retroperitoneal masses.
hernia repair and controlateral open partial nephrectomy in one Within the available literature, in roughly one half of the
case, and laparoscopic cholecystectomy in another) and its cases (13 out of 27, 48%) the finding of a retroperitoneal process
time was subtracted from total. Blood loss ranged from 0 to was incidental and patients were asymptomatic. Abdominal or
200 mL and blood transfusions were not required. One bowel flank pain at presentation accounted for 11 cases, abdominal

Table 1: Demographics, clinical presentation and imaging findings in our series
Patient Gender Age Presentation Symptomatic Side Size
no. (M/F) (Years) (Yes/No) (L/R) (cm)
1 M 60 Work-up for systemic disease Yes L 2
2 M 56 Follow-up imaging (RCC) No L 2
3 M 68 Follow-up imaging (RCC) No R 5
4 M 56 Incidental No L 10
5 F 52 Incidental No R 4
6 M 73 Follow-up imaging (RCC) No R 4
7 F 53 Flank and abdominal pain Yes L 16
8 F 46 Flank and abdominal pain Yes L 12

Table 2: Surgery characteristics and postoperative course in our series
Patient Preoperative Final Malignant Procedure Operative Compli- Hospital Follow-up
no. biopsy pathology (Yes/No) time (Min) cations stay (days) (months)
1 No Lymphoma Yes Incisional biopsy 60 No 2 24*
2 No RCC (local recurrence) Yes Excision 270** colon injury 7 50
3 No RCC (local recurrence) Yes Excision 120 No 6 38
4 No Schwannoma No Excision 150 No 3 35
5 Mesenchymal
tumor Sarcoma Yes Excision 120 No 3 18
6 RCC RCC (local recurrence) Yes Excision 110 No 2 13
7 No Adrenal cyst No Excision 140 No 2 13
8 No Retroperitoneal cyst No Excision 80*** No 6 5
Average 131.25 3.88 24.5
RCC – Renal cell carcinoma
* Lost on follow-up
** Concomitant laparoscopic postoperative ventral hernia (POVH) repair and controlateral open partial nephrectomy (operative time
detracted from total)
*** Concomitant laparoscopic cholecystectomy (operative time detracted from total)

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