Anaesthesia management of a giant retroperitoneal liposarcoma: a case report and literature review

Soft tissue sarcomas account for less than 1% of all malignant tumors, of which 10∼15% are located in the retroperitoneum, and liposarcoma constitutes 20% of all soft tissue sarcomas. Of note, retroperitoneal liposarcoma is a rare malignant tumor, with recurrence and asymptomatic characteristics at the initial stage until the liposarcoma is large enough to compress abdominal organs. Those larger than 20 kg, known as "giant liposarcomas," are extremely rare. Most retroperitoneal liposarcoma represents expansive growth, and lymph node metastasis or distant metastasis is rarely reported, making surgical resection as the most effective treatment. Because giant retroperitoneal liposarcomas can cause substantial compression of abdominal and retroperitoneal structures, perioperative management may be complicated by impaired venous return, respiratory compromise, hemodynamic instability, difficult tumor dissection, and major blood loss. Current consensus emphasizes management of primary retroperitoneal sarcoma in experienced multidisciplinary centers. In addition, recent perioperative literature highlights the importance of individualized preoperative optimization, invasive hemodynamic monitoring, goal-directed fluid therapy, adequate blood-product preparation, and structured postoperative care. In this context, we reported a case of a giant retroperitoneal liposarcoma with a diameter 52 cm× 38 cm×30 cm and a weight of 31 kg. Through multidisciplinary team (MDT) consultation, the tumor compressing the surrounding organs was successfully removed.