A 66-year-old woman, Mrs. Zhang, presented to Beijing Jishuitan Hospital with back pain, where imaging revealed a retroperitoneal mass in the splenorenal space. Further evaluation showed the tumor was closely adjacent to the ribs and diaphragm, with PET-CT indicating a high metabolic activity suspicious for malignancy, though no distant metastases were found.
Dr. Zhou Ning, Deputy Chief Physician of Urology, noted that while the tumor’s regular shape on imaging was atypical for cancer, elevated metabolic activity warranted concern. Given retroperitoneal tumors’ high malignant potential and anatomical complexity—often involving multiple organs—surgical resection was deemed necessary. The tumor’s proximity to the chest wall structures suggested a combined urology-thoracic surgery approach might be required to remove it completely.
Innovative Minimally Invasive Strategy Developed
The multidisciplinary team devised a hybrid approach combining laparoscopic exploration with intercostal mini-incision assistance:
Urology would lead the intra-abdominal dissection using laparoscopy to assess the tumor’s relationship with surrounding tissues.
Thoracic surgery would provide access to the chest wall via a small intercostal incision, addressing areas unreachable by laparoscopy to ensure radical resection.
This strategy leveraged laparoscopy’s minimally invasive benefits while allowing direct visualization through the intercostal incision, avoiding the extensive trauma of traditional open surgery and overcoming single-department limitations.
Successful Operation with Minimal Trauma
During surgery, Dr. Zhou first used laparoscopy to carefully dissect the tumor, confirming it had not invaded the ribs or diaphragm, thus avoiding unnecessary organ resection. When reaching the critical chest wall-adjacent region, Dr. Zhang Dong of the thoracic team completed the final dissection through a 4 cm intercostal incision, removing the tumor intact.
Postoperatively, Mrs. Zhang had only three 1 cm abdominal puncture sites and a small chest incision—70% smaller than traditional open surgery incisions. The procedure featured minimal blood loss and preserved normal tissue function. She recovered well with aesthetically pleasing wound healing.
Significance of Multidisciplinary and Minimally Invasive Care
This case exemplifies the power of multidisciplinary team (MDT) collaboration in managing complex tumors, combining urological and thoracic expertise for optimal outcomes. The innovative technique demonstrates how minimally invasive approaches, through precise evaluation and technical innovation, can transform “major surgeries” into “minor traumas,” offering better treatment options for retroperitoneal tumor patients.
Retroperitoneal tumors often present with subtle early symptoms. Patients with back pain or abdominal masses detected on imaging are advised to seek specialized evaluation promptly. Early intervention and multidisciplinary treatment remain critical to improving outcomes for these challenging cases.
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