🏥Life Within a 17.5kg Tumor: A Deep Dive into Surgical Decision Logic

📍 Facing a twice-recurrent 17.5kg Leiomyosarcoma, a surgeon’s first priority is not the incision, but a "strategic gamble" of clinical logic.

🔍 Protocol Screening: Why skip the conventional path?

💡 We initially rejected "staged resection." Given the hypervascular nature of the tumor and the patient's cachectic state, the reperfusion injury and hemodynamic shock from staged procedures would likely trigger Multiple Organ Dysfunction Syndrome (MODS).

🚫 We also ruled out purely conservative care, as the 32.5cm mass posed an imminent lethal compressive threat.

🧠 Core Logic: Physical compression does not equal anatomical fusion.

📉 Despite imaging showing a "frozen abdomen," palpation revealed a resilient abdominal tone. This was a critical signal: the tumor likely possessed an intact pseudo-capsule. As long as the capsule wasn't extensively infiltrated, a dissection plane existed.

🛠️ Key Surgical Pivot Points:

💉 Vascular-First Approach: Pre-operative interventional embolization was performed on feeding arteries. For the splenic artery stretched to 50cm (3x its normal length) and tissue-thin, this was the only way to "decompress" the risk of rupture.

🤲 Mechanical Compensation: A 17.5kg mass generates fatal shear stress during repositioning. Two surgeons acted as "human scaffolds," cradling the tumor throughout to ensure gravity did not tear the retroperitoneal vessels.

🔪 Precision Dissection: We performed "nibbling" dissection along the pseudo-capsule, ultimately achieving an R1 resection.

✨ Outcome:

🏆 The 5-hour procedure resulted in only 600ml of blood loss. This proves that the synergy of clinical intuition and MDT can transform "inoperability" into a successful surgical indication.