What Are Retroperitoneal and Abdominal Sarcomas?
Retroperitoneal sarcomas (RPS) are rare tumours arising in the retroperitoneal space — the area behind the peritoneum containing the kidneys, major vessels, adrenal glands and retroperitoneal fat. They represent 15% of all soft tissue sarcomas. The most common subtypes are liposarcoma and leiomyosarcoma. They typically grow to large sizes before causing symptoms.
Symptoms
Most patients present with a palpable abdominal mass. Additional symptoms include: abdominal discomfort or fullness, back pain (compression of lumbar plexus or kidney), leg swelling (venous compression), early satiety and weight loss. In advanced disease: haematuria, neurological symptoms from nerve involvement.
Diagnosis
CT scan: First imaging modality. Characterises tumour, assesses vascular involvement and identifies distant metastasis. MRI: Better characterisation of retroperitoneal fat tumours and neural involvement. PET-CT: For high-grade tumours to assess metastatic disease. Biopsy: Core needle biopsy is required for histological diagnosis before surgery in most cases. Must be performed carefully to avoid seeding and should not compromise future surgical resection.
Surgery: The Only Curative Treatment
Complete en-bloc resection is the standard treatment. This typically requires removal of adjacent organs sharing fascial planes with the tumour (kidney, colon, spleen, adrenal gland) even when not overtly involved — the "compartment surgery" approach. For liposarcoma this reduces local recurrence. Resection by an experienced team at a high-volume sarcoma centre is associated with significantly better local control.
Adjuvant Treatment
Radiotherapy: pre-operative radiotherapy may improve margin quality in selected cases. Chemotherapy: limited role for liposarcoma and leiomyosarcoma. May be considered for high-grade tumours or when R0 resection is not possible. Targeted therapy: trabectedin is approved for liposarcoma and leiomyosarcoma second-line.
Have you been diagnosed with a retroperitoneal sarcoma? At Quenet Torrent Institute we specialise in the surgical management of retroperitoneal tumours. Request a consultation or second opinion.