Surgical Skills And Clinical Experience Of Laparoscopic Resection For Retroperitoneal Tumors Via Transabdominal Approach

Objective To summarize the surgical skills and clinical experience of laparoscopic resection for retroperitoneal tumors via transabdominal approach.Methods The retrospectively analysis were taken of 37 patients with retroperitoneal tumors who underwent laparoscopic resection at the general department of Fujian Medical University Union Hospital between January 2011 and December 2017.Results All operations were performed successfully.Four operations were converted to laparotomy due to severe adhesion of tumor to adjacent viscera or major vessels.Four operations were performed with laparoscopy-assisted.Four operations were taken laparoscopic biopsy,and the remaining operations were accomplished by laparoscope.The benign tumors were 29 cases,which included 11 retroperitoneal cysts cases,4 schwannoma cases,3 cystic lymphangioma cases,2 paraganglioma cases,2muture teratoma cases,1 hemangioma case,1 solid pseudopapillary tumor case,1inflammatory myofibroblastic tumor case,1 fibromatosis case,1 Castleman disease case,1 cystic mesothelioma case and 1 pheochromocytoma case.The malignant tumors were 8 cases,which included 5 lymphoma cases,1 leiomyosarcoma case,1enterogenous mucous cystadenocarcinoma case and 1 retroperitoneal gastrointestinal stromal tumor case.The mean operative time was 181.1±72.7minute and the mean estimated intraoperative blood loss was 159.6±86.5ml.The mean value of time of returning to diets was 2.3±1.6 days and the mean postoperative hospital stay was6.6±3.6 days.The main postoperative complications included chylous fistula(2 cases)and delayed gastric emptying(1 case).There was no death at perioperative period.All patients were followed up for 6 to 85 months.The mean follow-up time was 32.6months.One patient with inflammatory myofibroblastic tumor experienced recurrence at 15 months after operation,which underwent further resection.The patient had liver metastases at 9 months after the second operation,which underwent further interventional operation.Five patients of Lymphoma and One patient of Castleman disease received chemotherapy in internal medicine after operation.The other patients experienced no recurrence or metastasis.There were no significant differences in the operative time,postoperative dietary time,intraoperative blood loss and postoperative hospital stay between large diameter(≥10cm)retroperitoneal tumors group(n=18)and small tumor diameters group(n=19)(P>0.05).The operation time and the intraoperative blood loss in the retroperitoneal tumor adjacent to the important blood vessel or organ group(n=17)were higher than those in the tumor away from the important blood vessel or organ group(n=20)(P<0.05).The operation time,the postoperative hospital stay and the intraoperative blood loss were lower in the retroperitoneal cystic tumor group(n=15)than those in the retroperitoneal non-cystic tumor group(n=22)(P<0.05).Conclusion With sufficient preoperative preparation,fine intraoperative operation,and rich experience in laparotomy and laparoscopic surgery,laparoscopic surgery via transabdominal approach has important clinical significance for retroperitoneal tumors,the advantages of which include high efficiency,minimal invasion and rapid recovery.It is indicated that this technique is safe,feasible and worth promoting.