Value estimation and comparison of diagnostic methods for primary retroperitoneal tumours: Summary of Ph.D. Thesis in Medical Sciences: 321.13 - Surgery

Abstract

Timeliness and importance of the issue addressed: Primitive retroperitoneal tumors (PRTs) develop in the space delimited by the posterior parietal peritoneum and endoabdominal fascia, comprising extraorganic structures of fatty, connective, fascal, vascular, nervous, muscular fascicules, lymph vessels and nodes or embryonic vestiges, more commonly derived from the urogenital apparatus. [1,2,3,4,5]. PRT are rare tumors, representing 0.2% of the 60,000 tumors researched by Pack and Tabah, 0.07% of 30,000 collected by Bucalossi [7,16]. Russian literature mentions the rarity of PRT, providing data on the incidence of 0.03-1% of all human tumors [8,9,10]. According to the data taken from the "National Cancer - Registry" of the Department of Monitoring, Evaluation and Integration of Medical Care Services of the Oncology Institute of the Republic of Moldova, during a calendar year there are registered in the average 15-18 cases of PRT, which constituted 0.7%. Benign or malignant retroperitoneal tumors derive from a wide variety of tissues, so their classification is mainly by histological parameter (tissue of origin). These tumors are indepedent to the retroperitoneal organs: pancreas, adrenal, kidney, ureter or viscera in the vicinity. Depending on the tissues of origin, PRTs can be classified [11] in tumors of mesodermic origin, ectodermic and origin in embryonic vestigial tissues. Developed in retroperitoneal space, PRT is a heterogeneous group of oncological diseases with late diagnosis, malignancy in about 80% of cases, and only 20% benign [12]. Clinical signs appear as a consequence of compression or invasion of organs in the vicinity. The emerged clinic is a secondary one, characteristic of the affected adjacent organ. According to literature data, tumors with a size less than 5 cm in diameter can be incidentally diagnosed [13,16], the most common PTR are diagnosed at a diameter size greater than 10 cm, with an average of 13.7 cm [14,15]. In the treatment plan, the surgical one remains to be of choice. For the determination of treatment tactics, timely diagnosis of these tumors is indispensable. The diagnostic algorithm is uncertain, being adapted for each clinic, depending on the existing possibilities. Abdominal ultrasound remains to be the most important and used investigation highlighting the tumor, indicating its solid or cystic character, but cannot always state the tumor's organ belonging and its visceral or vascular relationships. Much more valuable in terms of diagnosis are computed tomography (CT) and magnetic resonance investigation (MRI). These methods of investigation can easily determine tumor location, organ membership and visceral or vascular relationships, but a definite diagnosis is established only after the histological examination of the operative part [1,16]. The low incidence, the clinical, histological polymorphism and the anatomical peculiarities of the retroperitoneal space create difficulties even for the most experienced surgeons and oncologists [6]. In this context, the scientific research focused on the diagnosis and treatment of PTR remains to be current and present. Aim of the study: Estimating the informativity and specificity of diagnostic methods of Primitive Retroperitoneal Tumors for the elaboration of a practical behavior algorithm in the diagnosis of patients with PTR from the Republic of Moldova. [...]