Retrospective Study Of Imaging Diagnosis,Surgery And Postoperative Complications Of Retroperitoneal Tumors

IntroductionRetroperitoneal tumors(RT)are rare in clinical practice,accounting for 0.2-0.6%of all tumors.There are no obvious symptoms in the early stage,and the diagnosis depends mainly on images.Complex retroperitoneal tumors are close to major blood vessels,nerves and organs.Even for experienced surgeons,to complete resection of retroperitoneal tumors and minimize postoperative complications while maintaining surgical safety remains a challenge.Objective1.To retrospectively analyse imaging diagnosis of retroperitoneal tumors.2.To retrospectively analyse surgery and postoperative complications of retroperitoneal tumors.MethodsThe medical records of 192 patients with retroperitoneal tumors admitted to our hospital from October 2001 to January 2019 were collected.181 cases underwent radical surgery(131 open surgery and 50 laparoscopic surgery).The remaining 1 patient underwent ultrasound-guided retroperitoneal cyst drainage,3 underwent palliative surgery,and 7 underwent exploratory surgery.Results1.106,171,30,and 19 cases underwent B-ultrasound,CT,MRI,and PET-CT,respectively.The detection rate was 96.23%,100%,100%,and 100%.The correct rate of benign and malignant tumor of CT,MRI,and PET-CT was77.19%,80.00%,and 63.16%.Univariate analysis showed that the maximum tumor diameter>9 cm was the predictor of malignant tumors(P<0.05).Although a small number of retroperitoneal tumors have strong features in the image,diagnosis still depends on pathology.2.47 patients(26.0%)underwent combined organ resection and 14 patients(7.7%)underwent major abdominal vascular structures repair.Compared with open surgery,laparoscopic surgery had a smaller amount of intraoperative red blood cells(70±243 vs 236±408 ml),shorter operation time(164±99 vs199±99 min),and shorter postoperative hospital stay(7±4 vs 12±8 days).(P<0.05).After surgery,17 patients(9.4%)were transferred to the intensive care unit(ICU).The incidence of complications after open surgery was 45.0%.The most common were low fever(13.7%),wound fat liquefaction(8.4%),pulmonary infection(4.6%),and urinary tract infection(4.6%).The reoperation rate was 1.5%.The incidence of severe postoperative complications(Clavien-Dindo>III)was 10.7%.Univariate analysis showed that malignant tumor,intraoperative blood loss?200ml,operation time>180min,intraoperative red blood cell transfusion and intraoperative plasma transfusion were risk factors for postoperative complications.Multivariate logistic regression showed that the amount of intraoperative blood loss>200ml and operative time>180min were risk factors for postoperative complications.(P<0.05).The incidence of complications after laparoscopic surgery was 34.0%.The most common are low fever(10.0%),hypokalemia(8.0%),vomiting(6.0%),and lower extremity venous thrombosis(6%).The reoperation rate was 0.The incidence of severe postoperative complications(Clavien-Dindo? ?)was 12.0%.Univariate analysis showed that the maximum diameter of the tumor?10cm,the intraoperative blood loss?300ml,and the intraoperative transfused red blood cell?500ml were risk factors for postoperative complications.Multivariate logistic regression showed that the amount of intraoperative blood loss?300ml was a risk factor for postoperative complications.(P<0.05).No patients died during the perioperative period.Conclusion1.There is lack of specific symptoms in the early stage of retroperitoneal tumors.The diagnosis depends mainly on images.The detection rate of CT,MRI and PET-CT reached 100%.The maximum diameter of the tumor>9 cm suggests that the tumor is malignant.Different types of tumors have different imaging features,and the final diagnosis depends on the "gold standard" pathology.2.Surgery is the main treatment for retroperitoneal tumors.When there are surgical indications,laparoscopic surgery and open surgery are equally safe and effective.Laparoscopic surgery has the advantages of less intraoperative transfused red blood cell,shorter operation time,shorter postoperative hospital stay,and fewer postoperative complications.Methods like precise operation for reducing the amount of intraoperative blood loss can reduce the occurrence rate of postoperative complications.