Knacks and pitfalls of retroperitoneal sarcoma surgery, part 2: practical tumor resection in Nagoya University

Figures

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  Fig. 1. A case of intrapelvic undifferentiated pleomorphic sarcoma Axial (A) and coronal (B) computed tomography images indicate a large tumor originating from the pelvic floor. Several branches from the right internal iliac artery (arrowheads) fed the tumor, and these are embolized with multiple coils (arrows) one day before surgery (C, before embolization; D, after embolization).

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  Fig. 2. A case of a large left-sided leiomyosarcoma Axial (A) and coronal (B) computed tomography images indicate extensively engorged bilateral gonadal veins, suggesting that these vessels are major drainage veins of the tumor (arrowheads). Intraoperative photograph of a markedly engorged right gonadal vein (C). In this case, the left gonadal veins were dissected at the final stage of tumor resection.

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  Fig. 3. A case of a large intrapelvic undifferentiated pleomorphic sarcoma A large tumor received blood supply from numerous blood vessels in the pelvic floor. The bleeding point was grasped by forceps (A). At this point, it was notably difficult to perform a hemostatic maneuver because there was insufficient space due to the tumor hangover. After tumor removal, the bleeding points were processed individually (B).

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  Fig. 4. A case of a right-sided diaphragmatic inflammatory tumor involving the liver dome Axial (A) and coronal (B) computed tomography images indicate a tumor involving the liver dome (arrowheads). The tumor was resected with a wide portion of the diaphragm and the partial liver (C). The large defect of the diaphragm was patch-repaired using the fascia lata (arrows; D).

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  Fig. 5. A case of a large right-sided retroperitoneal liposarcoma Axial (A) and coronal (B) computed tomography images indicate that the tumor was in wide contact with the duodenum (arrowheads). There was no invasion of the tumor into the duodenum, and it was separated from the tumor (C and D). After tumor removal (E).

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  Fig. 6. A case of a large left-sided retroperitoneal liposarcoma Axial (A) and coronal (B) computed tomography images indicate that the tumor was in wide contact with the pancreatic body and tail (arrowheads). There was no invasion of the tumor into the pancreas, and it was separated from the tumor (C and D).

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  Fig. 7. A case of a large left-sided retroperitoneal liposarcoma The left renal artery is encircled with red tape from the back of the tumor (A). The left renal artery was dissected to avoid congestion. Thereafter, the left renal vein was processed (B). After tumor resection (C). The left hemicolon, pancreatic body and tail, and spleen were preserved.

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  Fig. 8. A case of a large left-sided retroperitoneal well-differentiated liposarcoma Axial (A) and coronal (B) computed tomography images indicate a large fat-dense tumor surrounding the left kidney. The tumor was resected while preserving the left kidney (C, left kidney is inverted; D, left kidney is in the normal position). The upper and lower poles of the kidney were fixed to the retroperitoneum to prevent torsion of the kidney.