A patient with large retroperitoneal liposarcoma - a challenge for an anesthesiologist
Retroperitoneal liposarcoma is a rare type of tumor characterized by slow growth and nonspecific symptoms, and is usually diagnosed at an advanced stage. Patients with huge retroperitoneal liposarcoma have a high risk of developing perioperative complications, and require special preoperative preparation and a carefully planned anesthetic approach. We present the case of a 57-year-old man, who was diagnosed with a huge retroperitoneal liposarcoma, 70 cm in diameter, weighing 30.4 kg and planned for surgical resection of the tumor under general anesthesia. Perioperative treatment and anesthesia for this patient were a great challenge for the anesthesiologist. However, due to preoperative preparation, monitoring and fluid replacement, hemodynamic and respiratory stability of the patient was maintained perioperatively.
Antinori A, Antonacci V, Magistrelli P. Giant retroperitoneal liposarcoma. Am J Surg 2002;184:56–7. doi: 10.1016/s0002-9610(02)00880-2.
Barbetakis N., Samanidis G., Samanidou E., et al. Primary mediastinal liposarcoma: A case report. J. Med Case Rep. 2007;1:161. doi: 10.1186/1752-1947-1-161.
J N Primrose, Soft tissue tumours. 3rd ed. F. M. Enzinger and S. W. Weiss. 1995. St Louis, Missouri: Mosby-Year-Book. British Journal of Surgery, Volume 82, Issue 10, October 1995, Page 1437. doi:10.1002/bjs.1800821050.
Dalal KM, Kattan MW, Antonescu CR, Brennan MF, Singer S. Subtype specific prognostic nomogram for patients with primary liposarcoma of the retroperitoneum, extremity, or trunk. Ann Surg. 2006;244(3):381–91.doi: 10.1097/01.sla.0000234795.98607.00.
Brennan MF, Antonescu CA, Maki RG. Management of soft tissue sarcoma. New York (NY): Springer; 2013. doi: 10.1007/978-1-4614-5004-7.
Kotera A, Kouzuma S, Miyazaki N, Taki K, Esaki K. Anesthetic management of a patient with an ultra huge ovarian tumor. Masui. 2009 Jul;58(7):907-9. PMID: 19618834.
Zhang W.D, Liu D.R, Que R.S, et al. Management of retroperitoneal liposarcoma: A case report and review of the literature. Oncol Lett. 2015; 10 (1): 405–9. doi:10.3892/ol.2015.3193.
Bradley JC, Caplan R. Giant retroperitoneal sarcoma: a case report and review of the management of retroperitoneal sarcomas. Am Surg. 2002 Jan;68(1):52-6. PMID: 12467318.
Feng D, Xu F, Wang M, Gu X, Ma Z. Anesthetic management of a patient with giant retroperitoneal liposarcoma: case report with literature review. Int J Clin Exp Med. 2015 Oct 15;8(10):19530-4. PMID: 26770605; PMCID: PMC4694505.
Ohashi N, Imai H, Tobita T, Ishii H, Baba H. Anesthetic management in a patient with giant growing teratoma syndrome: a case report. J Med Case Rep. 2014 Jan 27;8:32. doi: 10.1186/1752-1947-8-32. PMID: 24467840; PMCID: PMC3917373.
Nishiyama T, Hanaoka K. Same day drainage and removal of a giant ovarian cyst. Can J Anaesth. 1997 Oct;44(10):1087-90. doi: 10.1007/BF03019231. PMID: 9350369.
Shinohara H, Ishii H, Kakuyama M, Fukuda K. Morbidly obese patient with a huge ovarian tumor who was intubated while awake using airway scope in lateral decubitus position. Masui. The Japanese Journal of Anesthesiology. 2010 May;59(5):625-628.
Kondo T, Kusunoki S, Yasuuji M, Kawamoto M, Yuge O. Prevention of reexpansion pulmonary edema during resection of mediastinal tumor with atelectasis. Masui to sosei. 2006;42:39–41.
Mihara T, Kurahashi K. Re-expansion pulmonary edema (RPE) during surgery for intraabdominal giant tumor. Masui. 2008 Feb;57(2):191-6. PMID: 18277569.
Morrison P, Morgan G. Removal of a giant ovarian cyst. Anaesthetic and intensive care management. Anaesthesia. 1987 Sep;42(9):965-74. doi: 10.1111/j.1365-2044.1987.tb05368.x. PMID: 3674358.
Singh S, Bansal S, Kumar G, Gupta I, Thakur JR. Entropy as an Indicator to Measure Depth of Anaesthesia for Laryngeal Mask Airway (LMA) Insertion during Sevoflurane and Propofol Anaesthesia. J Clin Diagn Res. 2017Jul;11(7):UC01-UC03. doi: 10.7860/JCDR/2017/27316.10177. Epub 2017 Jul 1. PMID: 28893011;PMCID:PMC5583804.
Won YJ, Lim BG, Kim YS, Lee M, Kim H. Usefulness of surgical pleth index-guided analgesia during general anesthesia: a systematic review and meta-analysis of randomized controlled trials. J Int Med Res. 2018 Nov;46(11):4386-4398. doi:10.1177/0300060518796749. Epub 2018 Sep 9. PMID: 30198405; PMCID:PMC6259411