Retroperitoneal or mesenteric primary liposarcoma: clinical and prognostic evaluations on five cases.

BACKGROUND: Retroperitoneal or mesenteric primary liposarcoma is a malignant neoplasia whose prognosis depends on the biological variants, the radical resection surgery and the histological subtypes, as well as on local and remote recurrences. Liposarcoma is the most common variant of this tumour among tumours of soft retroperitoneal tissue. The purpose of this study is to evaluate whether the treatment of this disease, carried out at the Ivrea Hospital for urgent reasons, may be considered in line with the experience of high-volume Centres. PATIENTS AND METHODS: Between 1982 and 2016 five patients were hospitalized with a diagnosis of acute abdomen due to retroperitoneal or mesenteric primary liposarcoma: one myxoid of the mesentery, one well-differentiated of lesser epiploon, one well-differentiated of mesentery, and two dedifferentiates of the retroperitoneum. RESULTS: The five patients, all males, had a average age of 59 years (range 48-86) and were all subjected to general anaesthesia and open technique for total tumour removal. Only the patient with the myxoid liposarcoma had two recurrences. All are alive and healthy after a follow-up of 177 months (range 9-420). CONCLUSION: These tumours should be removed radically, if necessary in conjunction with contiguous organs. Rarity and therapeutic complexity require a treatment, sometimes even multimodal, in highvolume centres. Patients admitted in General Surgery Unit for unpostponable urgency should be operated by surgeons experienced in the treatment of abdominal disease to achieve survival results in line to those achievable in Hub Centres.

Goserelin Depot Treatment Before Endometrial Resection

To ascertain whether treatment with a gonadotropin-releasing hormone agonist before endometrial resection reduces absorption of distention fluid and operating time, facilitates the procedure, and improves long-term bleeding pattern, 71 menorrhagic women were allocated to 8 weeks of goserelin depot treatment before operative hysteroscopy or immediate surgery in the early proliferative phase of the cycle. Eight patients withdrew from the study after randomization, leaving 33 in the goserelin arm and 30 in the immediate surgery arm. Mean (SD) operating time was 15.1 (9.0) minutes in the goserelin group versus 16.9 (9.5) minutes in the controls (mean difference 1.8 min, 95% CI -2.9-6.4). Mean (SD) distention medium deficit was, respectively, 422 (287 ml) and 564 ml (291 ml; mean difference 142 ml, 95% CI -4-288). Considering only the 29 women with adenomyosis, the mean (SD) fluid deficit was considerably less in the 19 goserelin-treated group than in the 10 controls, 299 (206) versus 597 (135) ml (mean difference 298 ml, 95% CI 149-447). The surgeons classified intraoperative difficulties as none in 6, minimal in 20, moderate in 7, and severe in no cases in the goserelin group; corresponding figures in the group without pretreatment were 2, 14, 13, and 1 (p = 0.02). At 12-month follow-up 35% of women in the goserelin group were amenorrheic, 23% hypomenorrheic, 42% eumenorrheic, and none hypermenorrheic. Corresponding figures in the immediate surgery group were, respectively, 20%, 30%, 37%, and 13%. Goserelin administration before endometrial resection may reduce absorption of fluid at surgery in some patients and may facilitate intrauterine operating conditions. Effects on long-term bleeding patterns were limited.