There is a large resectable (probably) retroperitoneal mass in the LUQ with suspicion of sarcoma, should nephrectomy should be done?
In such cases we do left upper compartment resection which usually requires en block removal of the lesion along with distal splenopacreatectomy and adrenalectomy. Regarding the lefrt kidney it can be usually preserved and only fatty capsule can be removed if there is not direct infiltration of the kidney. Sometimes resection of the diaphragm and lumbar musculature is also needed to achive R0.
As distant lesions are small we will also discuss with thoracic surgeons the possibility for video-assisted thoracoscopic resection at second stage. And adjuvant treatment depends on final histology.
You should start by obtaining a sufficient biopsy of the mass to provide a Grade . Your dose of surgery should match the Grade of the tumor in terms of aggressivity. If a sarcoma, you might pursue neoadjuvant (preoperative) radiation therapy. This will give you time to monitor the lung nodules. If this is Stage IV disease, a large resection is not likely a worthy undertaking.
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