Considerations for management of large retroperitoneal tumors: use of the modified thoracoabdominal approach.

Massive retroperitoneal tumors have been resected successfully from 20 patients by means of the modified thoracoabdominal approach. Of these 20 patients 19 had primary non-seminomatous testicular cancer and 1 had a primary leiomyosarcoma. Fourteen patients are currently free of tumor. Salient features of the successful management of these patients have been the use of intensive chemotherapy before attempted surgical resection, aggressive surgical efforts that may necessitate major vascular resections and, in particular, use of the modified thoracoabdominal approach, which is described and illustrated in detail.