Managing A Case of Massive Retroperitoneal Leiomyosarcoma Under Anaesthesia

Abstract

Smooth muscle cells, usually from the uterus, gastrointestinal tract, or soft tissues, are the source of leiomyosarcoma, an aggressive soft tissue sarcoma. Soft tissue leiomyosarcoma is hypothesised to develop from smooth muscle cells surrounding tiny blood arteries. It can also develop straight from the viscera, such as the uterus and digestive system. We discuss a case of a big retroperitoneal leiomyosarcoma that was removed under anaesthesia after being located close to important blood arteries and involving the left renal vessels. The left nephrectomy and the relatively lengthy surgery with significant blood loss made it difficult for the anesthesiologist to keep euvolemia and hemodynamic stability without producing acidosis, organ damage, coagulopathy, or acute kidney injury. For the treatment of complex procedures to be effective, anesthesiologists must be proactive and watchful, and they must maintain good communication with the surgeons.

Introduction

An aggressive soft tissue sarcoma generated from smooth muscle cells is leiomyosarcoma. Sarcomas are a diverse category of tumours that are malignant tumours that develop from mesenchymal cell lines and have distinct clinical, histologic, and radiological features. 0.7% of all cancers are soft tissue sarcomas, while 5–10% of all soft tissue sarcomas are leiomyosarcomas. The survival rates are among the lowest of all soft tissue sarcomas, and the prognosis is poor. More women than men (2:1) are affected, and the disease commonly strikes in the fifth and sixth decades of life. This gender distribution may be a reflection of the smooth muscle growth brought on by oestrogen. The location, grade, and stage of the primary tumour, as well as the existence of the metastatic disease, all affect the prognosis and course of treatment. The retroperitoneum is the most typical location of leiomyosarcoma involvement, accounting for about 50% of cases. Depending on the grade of the tumour, surgery, radiation therapy, and chemotherapy are the available treatments for leiomyosarcoma. Retroperitoneal tumours may exhibit abdominal bulk, pain, swelling, weight loss, nausea, and vomiting as signs and symptoms. Like other soft tissue sarcomas, leiomyosarcoma frequently manifests as an expanding, painless tumour. We describe a case of leiomyosarcoma that had comparable symptoms and was successfully treated under anaesthesia.

Discussion

Leiomyosarcomas are well known for their rapid growth and extensive vascularity. Due to their proximity to important blood arteries and potential for life-threatening haemorrhage, big retroperitoneal tumours put patients at higher risk of perioperative morbidity and mortality. This necessitates proactive and precise anaesthetic treatment. Our patient's primary anaesthetic worries were that I the large tumour may compress the major vessels, creating haemodynamic disturbances. ii) High vascularity and close closeness to important blood arteries cause a bleeding disorder. iii) A mass effect that causes the diaphragm to splint and lowers lung compliance. iv) To avoid acute renal damage in light of a single kidney.

In our situation, the haemorrhagic shock brought on by extensive bleeding from the surgical site was the main cause of concern. It is a potentially fatal condition that results in hypoxia, diminished tissue perfusion, haemodynamic instability, organ damage, and even death. In order to handle this issue, we got in touch with the blood bank and made sure enough blood products were reserved. We prepared for significant blood loss during surgery by securing two large-diameter cannulas and a central line. We provided fluid warmers so that huge volumes of fluid could be transfused without leading to hypothermia, which could exacerbate the coagulopathy. Additionally, we decided how much blood should be transfused and at what ratio.

Conclusion

If acute hypovolemic shock develops during surgery, acute surgical bleeding is a medical emergency with a high mortality rate, necessitating early and efficient treatment. Due to the ingestion and dilution of clotting components, it may also cause coagulopathy, which can be aggravated by cold and acidosis. The key components of this case's successful management are therefore the control of bleeding, supportive therapies for maintaining adequate tissue perfusion and oxygenation, maintaining normothermia, correction of anaemia, acidosis, and electrolyte abnormalities, and use of suitable blood products to correct coagulopathy.

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