Perioperative anesthetic management for resection of giant retroperitoneal tumors

The aim of this study was to summarize perioperative anesthetic management in patients undergoing resection of giant retroperitoneal tumors and to provide a reference for clinical practice.

This retrospective study analyzed data from 10 patients who underwent elective resection of giant retroperitoneal tumors (maximum diameter ≥ 15 cm) at a single institution between January 2018 and December 2023. Demographic characteristics, tumor features, preoperative preparations, intraoperative hemodynamic data, fluid and blood product administration, and postoperative complications were collected and analyzed. Descriptive statistical methods were applied.

The cohort included 1 male and 9 female patients, with median mean age of 56.5 year-old (range, 24-79 year-old). The median maximum tumor diameter was 33 cm (range, 22-50 cm). Preoperative multidisciplinary team consultations were conducted in 8 patients, and interventional vascular embolization was performed in 7 patients. All patients received general anesthesia with endotracheal intubation. Invasive arterial pressure monitoring was used in all patients, central venous pressure monitoring in 9, and FloTrac™/Vigileo monitoring in 6. The median operative duration was 260 minutes. The median intraoperative blood loss was 2,700 mL, and the median cumulative duration of hypotension was 32 minutes. Eight patients received blood transfusions (The median cumulative transfusion volume of red blood cells and plasma was 2,650 mL). Vasoactive agents were administered in all patients. Postoperative complications included nausea and vomiting (3 cases), atelectasis (2 cases), pleural effusion (2 cases), and surgical site infection (2 cases). No perioperative mortality occurred.

The principal anesthetic challenges during resection of giant retroperitoneal tumors were hemodynamic instability and massive hemorrhage. Comprehensive preoperative preparation, advanced hemodynamic monitoring, proactive management of intravascular volume, and adequate availability of blood products may be critical components in improving patient outcomes.