RETROPERITONEAL PLEOMORPHIC SARCOMA ENCASING THE RIGHT KIDNEY: PERIOPERATIVE CHALLENGES AND ANESTHETIC MANAGEMENT

Abstract

Background: Retroperitoneal sarcomas are rare malignant tumors, accounting for less than 1% of all malignancies. Pleomorphic sarcoma is an uncommon aggressive subtype that often presents late and requires extensive surgical resection. When encasing the kidney, these tumors present significant surgical and anesthetic challenges.

Case Presentation: A 60-year-old male (ASA III) presented with a progressively enlarging abdominal mass over four months. Imaging revealed a retroperitoneal sarcoma encasing the right kidney, and biopsy confirmed pleomorphic sarcoma. Preoperative evaluation showed stable cardiopulmonary function and normal laboratory parameters. The patient underwent laparotomy with en bloc right radical nephrectomy and tumor excision under combined thoracic epidural and general anesthesia. Invasive monitoring included a left radial arterial line and right internal jugular central venous catheter. Induction was achieved with glycopyrrolate (0.2 mg), midazolam (1 mg), fentanyl (150 µg), propofol (120 mg), and atracurium (40 mg). Anesthesia was maintained with oxygen, nitrous oxide, isoflurane, and epidural bupivacaine with fentanyl. Blood loss was approximately 1000 mL, managed with crystalloids and transfusion of two units of packed red blood cells. Hemodynamics remained stable throughout. The patient was electively ventilated overnight in the SICU and successfully extubated on postoperative day one. He was discharged on postoperative day six after an uneventful recovery.

Conclusion: Retroperitoneal pleomorphic sarcomas with renal involvement require multidisciplinary planning, invasive monitoring, and tailored anesthetic management. A combined epidural–general anesthesia technique, judicious fluid therapy, and elective postoperative ventilation can optimize outcomes in these high-risk surgeries