| Background and ObjectivePrimary pelvic retroperitoneal tumor(PPRT)originates from the pelvic retroperitoneal space,the presacral space,which excluding the type of tumor of the retroperitoneal organ or metastasis to the retroperitoneum.PPRT is located in the deep pelvic cavity,which often lack specific clinical manifestations,and has a low early-diagnostic rate.Once tumors are found,they tend to be large in size and invade adjacent organs.Which makes it difficult to completely remove the tumor,and leads to a high recurrence rate and poor prognosis.A retrospective review of 120 cases of female PPRT from the First Affiliated hospital of Zhengzhou University was performed to research clinical characteristics,surgical treatment and treatment experience,and so as to provide a basis for the diagnosis and treatment of diseases.Materials and Methods1.General data We analyse the clinical data of 120 female patients with PPRT retrospectively,who be operated in the first affiliated Hospital of Zhengzhou University from January 2011 to August 2018.Including age,clinical symptoms pel--vic examination,tumor markers,auxiliary examination,surgical resection type(R0/R1 resection),the operation time,the blood loss,tumor size,pathological results,recurrence and follow-up,etc.Follow-up included telephone following-up and outpatient or inpatient review.2.Statistical methods All data were analyzed using SPSS 22.0 statistical software for statistics.Qualitative data were expressed by chi-square test,and quantitative data were expressed by Independent-sample test.Quantitative data which meet to a normal distribution are represented as mean-standard deviation.Quantitative data which do not meet the normal distribution were expressed in median and quartile[M(P25,P75)].Kaplan-meier method was used for survival analysis.Statistical significance was defined as P<0.05(?=0.05).Results1.A total of 120 female patients with primary pelvic retroperitoneal tumors were collected,aged 1.6-78 years,with an average age of 39.5±16.1 years.The population of 40-60 years old accounted for 52.5%.The tumor diameter ranges from 1.2 to54.0cm,and the median tumor diameter was 9.0cm(interquartile range 6.0-13.0cm).The common clinical manifestations were abdominal symptoms such as abdominal distension,abdominal pain,lumbosacral pain and dyschezia(45%,54/120).The positive rates of rectovaginal examination,CT,MRI were 82.7%(91/110),40.3%(25/62),93.3%(28/30)respectively.Serum tumor markers were examined in 80patients which the positive rates of CA125,CA199,CEA were 12.5%(10/80),2.5%(2/80)and 3.75%(3/80).2.All patients underwent surgical treatment,including 94 cases of benign tumors(78.4%),26 cases of malignant tumors(21.6%).Complete tumor resection was performed in 100 cases(83.3%,100/120),including 84 cases of benign tumor(89.3%,84/94)and 16 cases of malignant tumor(61.5%,16/26).The tumor diameter of 59patients was less than 10cm,which had a complete resection rate of 91.5%(54/59).The tumor diameter of 61 patients was greater than or equal to10cm,which had a complete resection rate of 75%(46/61).When the tumor diameter was less than10cm,the operation time,the blood loss,the postoperative hospitalization,the anal exhaust time and surrounding tissue damage in the laparoscopic group were less than those in the open surgery group.The difference was statistically significant(t=-3.361P=0.036;t=-3.329 P=0.002;t=-3.212 P=0.002;t=0.40 P=0.001;?~2=12.926 P<0.001).When the tumor diameter was greater than or equal to 10cm,the blood loss,the postoperative hospitalization and the anal exhaust time in the laparoscopic group were less than those in the open surgery group,and and the difference was statistically significant(t=-2.22 P=0.031;t=-5.990 P<0.001;t=0.55 P=0.034).3.A total follow-up period was from 1.5 to 93 months,with an average follow-up of 39.7±24.0 months,and 101 patients were followed-up(84.2%).Benign pelvic retroperitoneal tumors were followed-up in 78 cases and recurrence in 8 cases(10.2%).Palliative resection was performed in all patients with recurrence.The median recurrence time was 16.9 months(2 to 34 months).Twenty-three cases of malignant tumor were followed up,and 11 cases had recurrence(47.8%).Which including 2 cases of radical tumor resection and 9 cases of palliative resection,with a median recurrence time of 8.5 months(1-22 months).Patients with recurrence underwent surgical treatment again.By the end of the follow-up,there were no signs of recurrence in benign tumors and 4 patients with malignant tumors died.The 3-year and 5-year survival rates of malignant pelvic retroperitoneal tumors patients with complete-resection were 87.6%and 54.3%,and that of patients with palliative excision were 42.1%and 17.2%.Conclusion1.Most PPRT patients are benign lesions,and part of patients may present non-specific clinical symptoms such as abdominal distension,abdominal pain,lumbosacral pain,etc.The middle-aged females are often high-risk population,the incidence between the ages of 40-60 years old.2.Gynecological examination and the doppler ultrasound can be used as for routine examination methods for PPRT patients'initial screening and postoperative follow-up.For patients with highly suspected pelvic retroperitoneal tumor,rectovaginal examination,enhanced Computer Tomography(CT),pelvic Magnetic Resonance Imaging(MRI)should be further conducted.3.Laparoscopy can be used as the preferred choice for tumors with diameter less than 10cm,which has no obvious vascular invasion,pelvic compact adhesion and other contraindications in laparoscopic surgery.For tumors with a diameter greater than or equal to 10cm or suspected organ-invasion,the surgical method should be determined based on the patient's condition and the surgeon's comprehensive surgical skills. |
PDF Full Text Request