Postoperative Mobility Impairment Following Retroperitoneal Schwannoma Excision

Case Overview

This case study delves into an incident involving a 64-year-old individual who had been grappling with persistent abdominal pain and fullness for several months. Diagnostic imaging techniques revealed a left retroperitoneal mass, initially suspected to be a sarcoma. Despite the uncertainty surrounding the mass’s nature, no biopsy was performed prior to surgical intervention.

The patient underwent surgery for the excision of this mass in July, which postoperative pathology identified as a schwannoma. Unfortunately, the patient suffered significant loss of function in their left lower extremity following the operation, necessitating the use of mobility aids such as a walker or wheelchair. This case called for an expert opinion from a seasoned surgical oncologist to determine whether the standard of care was upheld.

Questions to the expert and their responses

How often do you perform surgical excisions of retroperitoneal masses and manage postoperative care?

As a surgical oncologist at a large academic institution, my practice encompasses managing cases across various disease sites including sarcoma, peritoneal carcinomatosis, colon, and gastric conditions. I frequently conduct surgery for retroperitoneal masses and manage postoperative care.

What pertinent protocols should be followed prior to retroperitoneal mass excision?

In situations where the mass characteristics are unclear, we typically consider conducting a biopsy before surgery. Depending on its location, we also discuss potential complications such as nerve or vascular damage. These complications could lead to functional issues like those experienced by this patient.

Have you reviewed a case similar to above? If so, please briefly describe.

Yes, I have encountered similar cases where benign tumors were asymptomatic and we decided to monitor them instead of performing immediate surgery.

About the expert

This expert is a highly qualified surgical oncologist with over a decade of experience in general surgery and surgical oncology. They have completed multiple fellowships, including ones in thoracic surgery, surgical critical care, and surgical oncology at renowned institutions. Currently board-certified in general surgery, complex general surgical oncology, and surgical critical care, this expert actively contributes to their field through memberships in professional organizations like the American College of Surgeons and the Society of Surgical Oncology, as well as through numerous peer-reviewed publications.