Challenges in treating multiple recurrent liposarcomas and giant incisional hernia
Summary
Join us for an in-depth case study review on managing multiple recurrent liposarcomas and substantial incisional hernias. This session shines a spotlight on the challenges presented by these rare and complicated cases, including early diagnosis difficulties, prognosis affecting factors, risk management, and preferred treatment paths. Through the examination of a case involving a patient with recurrent retroperitoneal liposarcoma and a large incisional hernia, you'll gain insights into effective surgical intervention strategies and understand the crucial role of complete resection in improving survival rates. Register and learn from medical professionals across multiple specialties offering their analysis and possible solutions to these challenging clinical scenarios.
Learning objectives
- Understand the complexities and challenges in treating multiple recurrent liposarcomas and giant incisional hernia, as described in the provided case report.
- Be able to discuss the incidence, diagnosis, and prognosis of retroperitoneal liposarcoma and incisional hernias.
- Cite the preferred treatment options for retroperitoneal liposarcoma and giant incisional hernia, including their associated risks.
- Articulate the potential complications and co-morbidities that might present in patients with retroperitoneal liposarcoma and giant incisional hernia, referencing the patient case provided.
- Summarize the significant role of complete resection in improving survival rates from retroperitoneal liposarcoma, whilst highlighting factors influencing disease-free survival and recurrence risk.
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Challenges in treating multiple recurrent liposarcomas and giant incisional hernia - case report 1 Author: Iulia-Ce1ara Pop 1 1 Co-author: Cezara Pop2,3Aniela Popescu , 1,3ert-Andrei Solontai Coordinators: Dr. Mihai Toma , Lecturer Dr. Valentin Oprea Affiliation: 1. “Iuliu Hatieganu” University of Medicine and Pharmacy of Cluj-Napoca 2. “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș 3. "Constantin Papilian" Emergency Clinical Military Hospital of Cluj-Napoca INTRODUCTION DISCUSSION INTRODUCTION Retroperitoneal liposarcoma is a rare malignancy, accounting This case is characterized by the patient’s complex medical for approximately 50% of retroperitoneal sarcomas. Its overall and surgical history. incidence is low, estimated at 0.3-0.4% per 100,000 The large incisional hernia poses risks of bowel obstruction individuals. Early diagnosis is challenging due to its deep and evisceration, while tumoral compression is impairing location, and prognosis largely depends on factors such as respiratory function. tumor size, histologic subtype, and metastasis. Furthermore, Surgical intervention is therefore the preferred treatment. incisional hernias occur in 11-23% of laparotomy patients, Prognosis: favourable, but with a risk of recurrence of the with 10% of repairs addressing defects larger than 15 cm. tumour Evolution: the recovery shows positive evolution CASE REPORT A 58-year-old male patient presents for: Recurrent retroperitoneal liposarcoma Giant incisional hernia Associated conditions: chronic kidney disease, mild obesity, bilateral obstructed ureters CT: retroperitoneal tumor (275 x 180 x 150 mm), midline abdominal defect (170 x 120 mm), a 7 cm elevation of the right hemidiaphragm Treatment: En bloc excision of the lipomatous mass The 20 kg mass measures 450 x 350 mm and it encases Fig 1: Retroperitoneal liposarcom Fig. 2: Resected specimen the right kidney, terminal ileum, ascending colon, and (intraoperative view) right anterolateral peritoneum Right nephrectomy CONCLUSION Extensive right hemicolectomy with end-to-side ileo- Complete resection of retroperitoneal liposarcoma remains transervse anastomosis the gold standard treatment, significantly improving the 5-year Incisional hernia repair using an on-lay technique with a survival rate (from 16.7% to 58%). However , the disease-free lightweight macroporous polypropylene prosthesis (30 x survival rate of 34% is influenced by the tumor grade, 25 cm) resection margins, and vascular involvement, which correlate with recurrence risk. CONCLUSION Fig. 5: CT scan (axial view) Fig . 3:Abdominal wall reconstruction (intraopera Fig. 4: CT scan (sagital view) Scan for References Fig. 6: CT scan (coronary view)