Page 5 - World Journal of Laparoscopic Surgery

Laparoscopic Management of Retroperitoneal Masses: Our Experience and Literature Review

Table 3: Demographics, clinical presentation and imaging findings in literature
Author Gender Age (years) Presentation Symptomatic Side Size
(M/F) (Yes/No) (L/R/Median) (cm)
Viani F 49 Abdominal and flank pain Yes R 6
Melvin F 36 Abdominal pain Yes R 2.5
Kawabata F 43 Incidental No L NA
M 68 Incidental No NA NA
Nishio F 41 Abdominal mass Yes R 5
Ohigashi F 28 Incidental No R 3
Shalhav F 58 Incidental No L 3
NA 50 Incidental No L 2
NA 62 Loin pain Yes L 6
NA 62 Back pain Yes R NA
Cadeddu F 32 Abdominal pain Yes R 12
F 45 Incidental No L 20
F 35 Painful flank mass Yes R 12
Descazeaud F 62 Incidental No R 8
Funamizu M 55 Epigastric discomfort Yes M 6
Ishizuka M 36 Incidental No L 5
Johna F 37 Flank pain, lower limb sensory impairment Yes L 12
Morrison M 62 Incidental No NA 7
Akos F 18 Incidental No L 8
Chung M 46 Incidental No L 3
Dalpiaz F 61 Incidental No L 10
Minei M 39 Fever, suspect adrenal tumor Yes L 3.5
Cho F 27 Incidental No M 10
Tsukamoto F 36 Abdominal and back pain Yes R 11
Targarona F 45 Abdominal pain Yes L 12
Celia F 65 Abdominal pain Yes R 7
Trindade M 28 Painful flank mass Yes R 5

Average (range) (18-68) (2-20)
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mass, fever, and epigastric discomfort were the presenting group and ourselves reported incisional biopsies whether all
symptoms in 1 case each. In our series only one case presented others report complete excisions of the specimen. Considering
incidentally, and the most common cause of diagnosis was that only few papers deal with malignant pathology it is to
follow-up imaging for RCC (37.5% of cases). In found expect that the rate of incisional biopsies is higher than reported.
publications, average lesion size is reported to be 7.5 cm in its Combining all reported cases (literature and our experience)
largest diameter, ranging from 2 to 20 cm; malignant masses in with malignant pathology we find 3 incisional biopsies and 8
those reports are generally smaller (2-10 cm). On our experience complete excisions. From another point of view, diagnostic
malignant masses treated laparoscopically measured 2-5 cm laparoscopy is likely to produce more incisional biopsies than
indicating a cautious approach to laparoscopic indications. reported considering this surgical intervention as the last
Limitations of available preoperative imaging techniques diagnostic tool available when non invasive techniques have
and suboptimal feasibility of image-guided preoperative biopsy failed.
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account for the fact that only one group reported performing In the published papers malignant pathology is observed
guided biopsies and in that setting its accuracy was quite low. only in 6 out of 27 cases (22.2%) and in those cases radical
In our series preoperative biopsy was carried out in 2 cases and resection was performed in 4 cases whether in other 2 cases
was accurate in diagnosis in one patient. Those findings incisional biopsy was carried out in Table 4. No recurrences are
emphasize the need of novel techniques to establish a more reported in those papers; however this element is to be evaluated
accurate diagnosis in such challenging cases as retroperitoneal against a probable publishing bias. Moreover, in cases with
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masses. An accurate preoperative diagnosis is essential to malignant pathology only one group stated the follow-up
formulate an appropriate treatment plan. period and reported the absence of recurrence at 12 months.
Published papers report no conversions and this may be We believe that laparoscopy is a viable and valid alternative
due to extreme experience of the surgical team but publication not only as a diagnostic tool but also as a treatment option in
bias must be taken in consideration. It is understandable retroperitoneal masses. Clearly, an accurate patient selection is
however, that the growing experience in laparoscopic surgery paramount, especially when one deals with possibly malignant
increases its efficiency even in those delicate cases. Only one finding. There is little question regarding the feasibility of

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