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Retroperitoneal and Abdominal Sarcomas

(P 303) MULTIVISCERAL RESECTIONS AND URINARY TRACT RECONSTRUCTION TECHNIQUES IN THE SURGERY OF RETROPERITONEAL SARCOMAS: A CASE SERIES.

    Author(s)

  • Madelaine Hettler, MD (she/her/hers)

    Resident
    Sarcoma Unit, Department of Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University
    Mannheim, Baden-Wurttemberg, Germany

    • Co-Author(s)

  • CG

    Charlotte Gündisch, n/a

    Sarcoma Unit, Department of Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University
    Mannheim, Baden-Wurttemberg, Germany

  • HW

    Helene Weigl, MD (she/her/hers)

    Oncological Surgeon
    Sarcoma Unit, Department of Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University
    Mannheim, Baden-Wurttemberg, Germany

  • Melissa Harbrücker, MD (she/her/hers)

    Resident
    Sarcoma Unit, Department of Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University
    Mannheim, Baden-Wurttemberg, Germany

  • Franka Menge, MD

    Dr.
    Sarcoma Unit, Department of Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University
    Mannheim, Baden-Wurttemberg, Germany

  • KS

    Kay Schwenke, MD

    Department of Vascular Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University
    Mannheim, Baden-Wurttemberg, Germany

  • MM

    Maurice Stephan Michel, MD

    Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University
    Mannheim, Baden-Wurttemberg, Germany

  • CR

    Christoph Reissfelder, MD

    Department of Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University
    Mannheim, Baden-Wurttemberg, Germany

  • TW

    Thomas Worst, MD

    Department of Urology and Urosurgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University
    Mannheim, Baden-Wurttemberg, Germany

  • Jens Jakob, MD (he/him/his)

    Consultant Sarcoma Surgeon
    Sarcoma Unit, Department of Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University
    Mannheim, Baden-Wurttemberg, Germany

Objective: Surgical management of retroperitoneal and pelvic soft tissue sarcomas aims for complete (R0) resection, often requiring complex multivisceral procedures. While nephrectomy - performed in more than 50% of cases - is among the most common organ resections during retroperitoneal sarcoma surgeries, en-bloc resection of the urinary tract structures, including the bladder, ureter, and prostate, is considerably rarer, occurring in less than 5% of cases. Owing to its rarity and the complex anatomical location, surgical strategies for urinary tract reconstruction are challenging and not yet standardized.

Methods: This case series aims to present various surgical reconstruction techniques following nephrectomy, partial cystectomy, and prostatectomy and autologous kidney transplantation during sarcoma resections. Five complex cases were analyzed from a total of 46 retroperitoneal and pelvic sarcoma surgeries performed at the Sarcoma Center Mannheim between December 2023 and January 2025.

Results: The analysis included three retroperitoneal dedifferentiated liposarcomas and two pelvic sarcomas—one leiomyosarcoma and one epithelioid sarcoma of the prostate (Table 1). Continence-preserving reconstruction was performed in all cases and kidney preservation were also achieved in all cases. One case required autologous kidney transplantation into the iliac fossa due to semicircumferential tumor contact with the ureter, despite no evidence of direct renal infiltration. In the remaining cases, ureteral involvement was managed using a psoas hitch procedure, and partial bladder resections with direct suturing reconstruction. For the prostatic sarcomas, a primary vesicourethral anastomosis was performed.

Conclusion: Resection of retroperitoneal and pelvic soft tissue sarcomas often necessitates nephrectomy or partial resection of the urinary tract. Reconstruction poses a surgical challenge and requires close collaboration between urologic and visceral surgery teams, utilizing a range of established techniques—from direct suturing and psoas hitch procedures to autologous kidney transplantation.

Case summary
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