Standardized laparoscopic approach for retroperitoneal tumors: a single-center preliminary experience

Background: Retroperitoneal tumors are rare and heterogeneous lesions, and their surgical management remains challenging. Although laparoscopic techniques are increasingly adopted in abdominal surgery, a standardized minimally invasive approach for retroperitoneal pathology has not yet been clearly defined. The present study reports our preliminary single-center experience with a standardized laparoscopic management of retroperitoneal tumors. Methods: We retrospectively reviewed 36 patients treated for retroperitoneal tumors between 2017 and 2022. Patients were selected for a laparoscopic approach when lesion size was ≤10 cm and no vascular invasion was identified on preoperative imaging. Demographic, perioperative, histopathological, and follow-up data were analyzed. Postoperative complications were classified according to the Clavien-Dindo system. Results: Among the 36 patients, 22 underwent laparoscopic surgery, 14 open surgery, and 4 required conversion to an open approach. The mean operative time was 104 minutes for laparoscopic procedures and 168 minutes for open surgery. One patient in the laparoscopic group required postoperative blood transfusion (Clavien-Dindo grade II), with no other postoperative complications observed. Length of hospital stay was shorter after laparoscopy (3.2 vs. 8.8 days). Benign lesions were more frequently treated laparoscopically, whereas sarcomas and metastatic tumors were more commonly managed with an open approach. The laparoscopic technique was standardized by subdividing the retroperitoneum into defined anatomical regions, each associated with specific patient positioning, trocar placement, and surgical steps. R0 resection was achieved in all malignant cases, as confirmed by postoperative pathology. At a mean follow-up of 5 years, no recurrences were observed in either benign or malignant cases. Conclusions: Our preliminary experience suggests that a standardized laparoscopic approach for retroperitoneal tumors is feasible, safe, and reproducible in carefully selected patients. Nevertheless, the retrospective design, limited sample size, and exclusion of more complex cases represent important limitations. Larger multicenter studies are required to further validate these findings.