What is a retroperitoneal sarcoma?
Sarcomas are tumors that originate in the body's soft tissues: muscle, fat, blood vessels, nerves, and connective tissue.
When these tumors appear in the retroperitoneum (the space behind the peritoneum, where the kidneys, adrenal glands, and major blood vessels are located), we call them retroperitoneal sarcomas.
They are rare tumors, which makes it especially important that they are treated at centers with experience.
Most common types
Liposarcoma
- The most common retroperitoneal sarcoma
- Originates in fatty tissue
- Different subtypes with varying behavior
- Can reach large size before causing symptoms
Leiomyosarcoma
- Originates in smooth muscle
- Frequently arises from major vessels (vena cava)
- More aggressive behavior
Other types
- Undifferentiated pleomorphic sarcoma
- Solitary fibrous tumor
- GIST (gastrointestinal stromal tumor)
- Other less common sarcomas
Symptoms
Retroperitoneal sarcomas usually grow slowly and can reach large size before causing symptoms:
- Feeling of mass or lump in the abdomen
- Abdominal or back pain
- Feeling of fullness or early satiety
- Leg swelling (from vessel compression)
- Weight loss
- Sometimes, incidental discovery on imaging tests
Diagnosis
Diagnosis is based on:
- Imaging tests: CT and/or MRI to evaluate the tumor, its extent, and relationship with neighboring structures
- Biopsy: In most cases, a core needle biopsy guided by imaging is performed
- Staging studies: Chest CT to rule out lung metastases
Importance of accurate diagnosis
The exact type of sarcoma and its grade (aggressiveness) are essential for treatment planning. That's why the pathological study should be done by a specialist with experience in sarcomas.
Treatment
Surgery is the main treatment for retroperitoneal sarcomas. The goal is to completely remove the tumor with adequate margins.
Why is experience important?
Retroperitoneal sarcomas are complex tumors that:
- Can affect multiple organs and structures
- Require extensive and technically difficult surgeries
- The quality of the first surgery is crucial for prognosis
- Should be treated at specialized centers with multidisciplinary teams
Surgery
The intervention may include:
- Complete tumor removal
- Resection of adjacent organs if affected (kidney, colon, spleen, etc.)
- In some cases, surgery on major vessels
Compartmental resection
At specialized centers, compartmental resection is performed:
- Not only is the visible tumor removed
- Surrounding tissues and organs are also removed
- This reduces the risk of local recurrence
Surgery duration: Variable depending on complexity, can last several hours.
Hospitalization: Usually 7-14 days, depending on extent.
Other treatments
Radiotherapy
May be used:
- Before surgery (neoadjuvant) in some cases
- After surgery if margins are close
- Special techniques such as intraoperative radiotherapy
Chemotherapy
- Less effective in sarcomas than in other tumors
- Used in some specific subtypes
- May be indicated in metastatic disease
Targeted therapies
In some specific types of sarcoma, there are targeted molecular therapies that may be useful.
Recovery
Recovery depends on the extent of surgery:
- First weeks: Recovery from the intervention, pain control, resumption of eating
- First month: Progressive recovery of activity
- Following months: Gradual return to normalcy
If a kidney has been removed, the remaining kidney assumes its function without problems in most cases.
Long-term follow-up
Follow-up is very important in sarcomas because:
- They can recur locally even years later
- Some types can give late metastases
Follow-up protocol
- Periodic reviews
- Regular abdominal and chest CT scans
- Frequency according to tumor type and grade
- Prolonged follow-up (10 years or more in some cases)
Local recurrence
If the sarcoma recurs locally (reappears in the same area), a new surgery may be considered.
- The decision depends on extent and patient status
- Reoperations are more complex
- Team experience is even more important
The importance of specialized centers
Retroperitoneal sarcomas are rare tumors that require a specialized approach. The quality of the first surgery is crucial for long-term prognosis. If you have been diagnosed with a retroperitoneal sarcoma, it is essential to be evaluated at a center with experience in these tumors, where a multidisciplinary team can plan the best treatment for your case.
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