The diagnostic utility of retroperitoneoscopic tissue biopsy for unresectable retroperitoneal lesions excluding urogenital cancers

Makito MiyakeEmail author View ORCID ID profile,
Shinji Fukui,
Daisuke Gotoh,
Yoshiaki Matsumura,
Shoji Samma,
Yoshihiro Matsumoto,
Hitoshi Momose,
Shunta Hori,
Shuji Watanabe,
Takuya Owari,
Yosuke Morizawa,
Yoshitaka Itami,
Yasushi Nakai,
Takeshi Inoue,
Satoshi Anai,
Kazumasa Torimoto,
Katsuya Aoki,
Nobumichi Tanaka and
Kiyohide Fujimoto

World Journal of Surgical Oncology201917:35

https://doi.org/10.1186/s12957-019-1581-0

Received: 9 January 2019
Accepted: 11 February 2019
Published: 18 February 2019

Abstract

Background

Retroperitoneal tumors are an uncommon disease known to consist of a diverse group of benign and malignant neoplasms. Treatment of unresectable retroperitoneal lesions requires pathological diagnosis. Here, we report the utility and safety of retroperitoneoscopic biopsy for unresectable retroperitoneal lesions excluding urogenital cancers.

Methods

We analyzed 47 patients consisting of 23 (49%) and 24 (51%) cases that underwent retroperitoneoscopic tissue biopsy and open biopsy, respectively. The clinicopathological features, including postoperative complications, were compared between the two groups.

Results

Tumor pathology was diagnosed successfully with a single operation in all patients. Malignant pathology (68%) was more common than benign pathology (32%). The most common pathology was malignant lymphoma, which accounted for about 50% of all cases. There was no significant difference with respect to the age, sex, tumor size, presence of tumor-related symptom, histopathology, operative time, and complications. Three (13%) of 23 patients in the retroperitoneoscopic biopsy group received percutaneous needle biopsy before laparoscopic excisional biopsy because the evaluation of needle cores failed to confirm subclasses of diagnosed pathologies. One patient was converted to open surgery just after the initiation of operation due to severe adhesion of adjacent structures. We had two cases with iatrogenic urinoma due to ureteral injury after retroperitoneoscopic biopsy.

Conclusions

We conclude that retroperitoneoscopic biopsy is a safe and useful tool for benign and malignant retroperitoneal lesions, in comparison to open biopsy. It is critical to carefully examine the preoperative imaging for the location of tumors, especially those close to the renal pelvis and ureter.