Laparotomy to remove a large retroperitoneal mass

What is this?

This operation involves an abdominal incision to remove a large retroperitoneal mass situated at the very back of your abdomen. In order to remove the mass completely, we may also need to remove other organs such as a kidney, portions of the large or small bowel and blood vessels.

What alternatives are there?

Many of these large masses eventually turn out to be sarcomas. Most sarcomas are not very sensitive to radiotherapy of chemotherapy and are, therefore, best removed surgically. Surgery, therefore, is usually the only effective treatment for these tumours. Often, these masses become very large before a patient presents to his/her doctor and, as a result, the operation can require a very long incision and a significant amount of surgery inside the abdomen. This leaflet has been developed at Addenbrooke’s; it is based on joint working with the specialist medical and surgical oncologists who treat people with retroperitoneal tumours, including sarcomas.

What to expect before procedure

If you are taking Aspirin or Clopidogrel on a regular basis, you must discuss this with your urologist because these drugs can cause increased bleeding after surgery. There may be a balance of risk where stopping them will reduce the chances of bleeding but this can result in increased clotting, which may also carry a risk to your health. This will, therefore, need careful discussion with regard to risks and benefits. You will usually be admitted on the day before your surgery. You will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer and your named nurse. You will be asked not to eat or drink for 6 hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy. You will also be given an injection under the skin of a drug (Clexane(®) which, along with elasticated stockings provided on the ward, will help prevent thrombosis (clots) in your veins.

What happens during the procedure?

Normally a full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which improves or minimises pain after the operation. You will usually be given injectable antibiotics before the procedure to prevent infection, after checking for any allergies. The mass will be removed through an incision in the abdomen. This is normally a long incision in the midline although, on occasions, a sideways extension is required towards the side of the mass. A bladder catheter is normally inserted to monitor urine output and a drainage tube placed through the skin into the area from which the mass has been removed. Occasionally, it may be necessary to insert a stomach tube through your nose to prevent distension (bloating) of your stomach and bowel with air.

After the procedure

After the operation, you may remain in the Special Recovery area of the operating theatres before returning to the ward; visiting times in these areas are flexible and will depend on when you return from the operating theatre. You will normally have a drip in your arm and, occasionally, a further drip into a large vein in your neck. You will be able to drink clear fluids immediately after your operation and start a light diet within 3-4 days. We will encourage you to mobilise as early as possible and to take fluids as soon as you are able. The average length of stay is 9 days.

Potential side effects