Patient: XYZ
Comorbidities: Hypertension (HTN), Diabetes Mellitus (DM), and Coronary Artery Disease (CAD)
Clinical Presentation:
Patient presented with a progressively enlarging abdominal lump for 2 months. Evaluation revealed a massive right retroperitoneal sarcoma measuring 48 × 30 × 20 cm, making it one of the largest reported retroperitoneal sarcomas managed in Rajasthan. The remainder of the metastatic workup and imaging studies were within normal limits.
Procedure Performed:
Right Retroperitoneal Compartmental Resection comprising:
- En bloc excision of retroperitoneal tumor
- Right nephrectomy
- Right hemicolectomy
- Ileocolic anastomosis (EIA reconstruction)
- Omentoplasty
Major Surgical and Perioperative Challenges:
- Giant tumor bulk causing restricted operative access and significant technical complexity.
- Multiple comorbidities with borderline cardiac and renal reserve, increasing perioperative risk.
- Significant intraoperative blood loss necessitating blood transfusions.
- Requirement for prolonged and intensive postoperative ICU management.
- Multivisceral resection involving the right kidney and colon.
- Hemodynamic instability for approximately 72 hours secondary to major fluid shifts.
- High BMI adding to operative and anesthetic challenges.
- Prolonged operative duration of approximately 8 hours.
- Compression of the Inferior Vena Cava (IVC) and external iliac vessels resulting in distorted anatomy and technically demanding dissection.
- Intraoperative hypothermia due to prolonged exposure of a large body surface area.
Outcome:
- Successful R0 resection of retroperitoneal liposarcoma achieved.
- Patient remained under close postoperative monitoring with multidisciplinary ICU support.
- Gradual recovery with stabilization of hemodynamic parameters and organ functions.
- Discharged on Postoperative Day 8 in a vitally stable condition.
- No postoperative complications at the time of discharge.
