Abstract:

Objective

To explore the prevention and management of hemorrhage risks during resection of pelvic retroperitoneal tumor involving major blood vessels, and to summarize the experience in managing retroperitoneal pelvic tumors involving major blood vessels.

Methods

A retrospective analysis was conducted on the clinical data of 27 patients with pelvic retroperitoneal tumor involving major vessels(including the abdominal aorta, inferior vena cava, iliac vessels, and mesenteric arteries and veins) who were treated at Guangdong Provincial Hospital of Traditional Chinese Medicine between January 2020 and May 2024. The data included general clinical information (such as patient age, gender, body mass index, history of previous abdominal surgery, and whether the tumor was primary or recurrent), surgery-related information(ASA classification, operative time, postoperative hospital stay, and major postoperative complications),data related to hemorrhage prevention and management (preoperative strategies to mitigate bleeding risks,intraoperative transfusion of blood products and transfusion volume, and management of major vessels involved by the tumor), and three-dimensional reconstruction images.

Results

Among the 27 patients with pelvic retroperitoneal tumor involving major blood vessels, there were 13 males and 14 females, with a median age of 64.0 (51.0, 68.0) years. The median maximum tumor diameter was 10.5 (6.5, 20.0) cm, with 15 cases (55.6%) being primary tumors and 12 (44.4%) being recurrent tumors. The average preoperative hemoglobin level was 112.9±3.7 g/L. In terms of vascular involvement, the abdominal aorta was involved in 5 cases (18.5%), inferior vena cava in 2 (7.4%), iliac artery in 6 (22.2%), iliac vein in 2 (7.4%), both iliac artery and vein in 2 (7.4%), splenic artery in 1 (3.7%), left renal vein in 1 (3.7%), both left renal artery and vein in 1 (3.7%), inferior mesenteric arteries and veins in 1 (3.7%), both inferior vena cava and iliac artery in 2 (7.4%), both inferior vena cava and right renal vein in 1 (3.7%), both inferior vena cava and left common iliac artery in 1 (3.7%), both left gastroepiploic vein and left renal vein in 1 (3.7%), and superior rectal artery in 1 (3.7%). Depending on the specific circumstances, treatment strategies included blunt dissection,intermittent vascular occlusion and suspension, vascular ligation, or combined organ resection, all of which successfully achieved complete tumor resection. The median intraoperative blood loss was 300.0 (100.0,700.0) ml, and 10 patients (37.0%) required intraoperative blood transfusions, mainly red blood cells and fresh frozen plasma. Postoperatively, 8 patients (29.6%) were admitted to the intensive care unit, and the median postoperative hospital stay was 15.0 (12.0, 25.0) days. The most common pathological type was liposarcoma, accounting for 9 cases (33.3%).

Conclusion

For resection of pelvic retroperitoneal tumor involving major blood vessels, it is crucial to prepare sufficient blood products preoperatively and formulate comprehensive surgical plans. In addition to preparing for vascular replacement, preoperative placement of vascular occlusion bands before tumor dissection is essential to prevent sudden massive hemorrhage from major vessels. Full attention should be given to effective prevention and control of bleeding risks.

Key words: Retroperitoneal pelvic floor tumor, Major blood vessels, Bleeding risk, Surgical option