ObjectiveTo summarize the strategies for determining resectability, intraoperative tumor management techniques, and perioperative risk control in primary retroperitoneal tumors (PRT), so as to ensure patient safety during the perioperative period and achieve favorable outcomes. MethodsA retrospective analysis was conducted on the clinical data of 122 patients with PRT who underwent surgical treatment at the Affiliated Cancer Hospital of Zhengzhou University from March 2017 to March 2023. The treatment process, surgical strategies, and key points of perioperative management were analyzed, and the clinical characteristics and perioperative management experience of this disease were summarized. And the influencing factors of postoperative complications were analyzed. ResultsAll 122 PRT received comprehensive imaging evaluation before surgery. After postoperative pathological diagnosis, 105 cases were malignant and 17 were benign. Among them, 10 underwent simple biopsy, 31 underwent simple tumor resection, and 81 underwent combined organ resection. The following factors were associated with a higher probability of postoperative complications: seeking medical attention due to symptoms (P=0.042), tumors predominantly located in the retrorenal space (P=0.015), tumors crossing the midline (P=0.002), incomplete tumor capsule (P=0.014), and tumors located in the pelvic cavity (P=0.023). ConclusionsContrast-enhanced CT and MRI are the primary modalities for preoperative diagnosis and evaluation of PRT. However, surgical risks are considerably higher in certain subgroups, including patients with symptomatic presentation, tumors in the retrorenal space or pelvis, tumors crossing the midline, or those with an incomplete capsule. Comprehensive perioperative assessment and targeted risk prevention are therefore critical to improving outcomes.