Challenges in the Surgical Treatment of Retroperitoneal Sarcomas

Abstract

The objective of this study is to assess long-term prognosis and patterns of failure in patients with retroperitoneal sarcoma who underwent surgery with curative intent at a single institution. We also provide a thorough review of the literature including several series and widely variable data regarding local and distant failure. During a 25-year period , 45 consecutive patients who underwent surgery for retroperitoneal sarcoma at a single referral center were reviewed retrospectively. We recorded and analyzed the presenting symptoms, type of surgical excision, and the 5-year survival rate as well as the local recurrence rate of patients with complete tumor resection. Overall survival is significantly diminished in patients in whom resection margins are not adequate. In our series, 5-year recurrence rate for patients with complete and incomplete resection of the tumor was 30.76 and 68.42 %, respectively. The 5-year survival rate was 51.12 %, and the 5-year survival rate according to type of resection was 76.93 % for complete and 15.79 % for incomplete resections. Local recurrence after first surgery and high-grade malignancy are associated with poor survival. The role of radiation therapy and chemotherapy in the treatment of retroperitoneal sarcoma (RPS) should be investigated further. Complete en bloc resection of the tumor mass and adjacent structures is the single most important factor that improves survival.

Comprehensive Surgical Treatment as the Mainstay of Management in Retroperitoneal Sarcomas: Retrospective Study from Two Non-sarcoma Specialist Centers

“…The adverse effect of incomplete resection (R2) on OS was also reported (HR=3.50; 95% CI=1.15-10.65; p=0.027). With regards to recurrence rates, those reported in the literature range between 26% and 49% depending on the follow-up period (16,25,31,34). The recurrence rate in our study over a follow-up period of 83 months was 43.33%, which is in fact almost identical to the rates reported for other cohorts with similar or longer followup when using the same surgical approach (contiguously involved organ resection) (25,29,31,34).…”

“…The demographics of our study population are similar to those of other published series. Liposarcoma is the most common histology (59%) followed by leiomyosarcoma (17%) (3,4,31), the majority of patients present with a tumor size between 10 and 33 cm and over half of all patients present with medium-/ high-grade tumors (57%) (3,13,14,17,24,25,32,33). The prognostic significance of high tumor grade as predictor of recurrence (p=0.014) and tumor related death (p=0.031) was recorded, again in line with larger published series (4,10,23,25,32).…”

“…With regards to recurrence rates, those reported in the literature range between 26% and 49% depending on the follow-up period (16,25,31,34). The recurrence rate in our study over a follow-up period of 83 months was 43.33%, which is in fact almost identical to the rates reported for other cohorts with similar or longer followup when using the same surgical approach (contiguously involved organ resection) (25,29,31,34). Five-year DFS and OS rates were comparable to those previously reported by other surgical groups (24,25,31,34,35).…”

Robotic resection of a giant retroperitoneal leiomyosarcoma: A case report

“…The surgical resection of RPLM can be associated with significant morbidity given that they usually invade important vascular structures such as the inferior vena cava (IVC) and tributaries, the duodenum and the ureter (11). The intraoperative 30-day mortality rate has been reported to be as high as 15% in resections of RPLMs arising from the IVC (12). However, a curative intent operation entails a wide resection incorporating the tumor and all the involved structures (e.g duodenum, colon, kidney, IVC) in order to achieve adequate resection margins (13).…”

Routine Drainage of Colorectal Anastomoses: An Evidence-Based Review of the Current Literature

“…A multivariate analysis [ 22 ] of the predictive risk factors for AL after small bowel and colorectal anastomoses found that although drains were used in more than 90% of patients, the use of drains did not confer a significant benefit to the patients as 12.4% of drained patients developed AL compared to 15% of nondrained patients (OR = 1.06, p = 0.92). Summary of the studies that concluded no clinical benefit of routine drainage after colorectal anastomosis is illustrated in Table 2 .…”