Long-term morbidity after multivisceral resection for retroperitoneal sarcoma

Callegaro, Dario; Miceli, Rosalba; Brunelli, Cinzia; Colombo, Chiara; Sanfilippo, Roberta; Radaelli, Stefano; Casali, Paolo G.; Caraceni, Augusto; Gronchi, Alessandro; Fiore, Marco

doi:10.1002/bjs.9829

Cited by 48 publications

(32 citation statements)

References 26 publications

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“…However, the ability to achieve complete resection remains a challenge . This difficulty, related to the paucity of specific symptoms contributing to a late presentation and a far‐advanced stage, and the propensity of genitourinary sarcoma to invade critical abdominal and pelvic structures, is evident in the finding of positive margins in 20.9% of our patients. In our daily clinical practice, we tended to carry out salvage chemotherapy and/or radiotherapy for patients with positive surgical margins; just three patients with positive surgical margins underwent re‐operation of residual tumor resection.…”

Section: Discussionmentioning

confidence: 93%

Adult genitourinary sarcoma: Clinical characteristics and survival in a series of patients treated at a high‐volume institution

Wang

Tan

et al. 2017

Int J of Urology

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Abbreviations & Acronyms B = bladder HR = hazard ratio K = kidney LRFS = local recurrence-free survival MFS = metastasis-free survival NR = not reported OS = overall survival P = paratesticular RMS = rhabdomyosarcoma Objectives: To report our institutional experience in the management of adult genitourinary sarcoma. Methods: This was a retrospective analysis of data on adult genitourinary sarcoma treated at the West China Hospital, Sichuan University, Chengdu, Sichuan, China from 1985 to 2010. Clinicopathological parameters were analyzed to determine their impact on overall, recurrence-free and metastasis-free survivals. Results: A total of 46 women and 142 men were included, with a median age of 42 years. Of these, 152 cases were high-grade. The most common site was the paratesticular region. Surgical resection was carried out in 155 patients (82.4%), with negative margin in 106. After a minimum follow up of 5 years, 20 patients (11.6%) survived disease-free, 14 (8.1%) were alive with disease and 138 (80.2%) died of disease. Survival rates at 1, 3 and 5 years were 91.3%, 64.0% and 47.7%. In univariate analyses, liposarcoma, high grade, metastasis at diagnosis, a lack of surgical resection and positive margin were predictive of unfavorable survival. In multivariate analyses, high grade, a lack of surgical resection and chemotherapy were independent predictors of poor survival. Conclusions: Adult genitourinary sarcoma is an aggressive malignancy, usually presenting at advanced stage, with a high incidence of recurrence and metastasis. Complete resection and selective combination of chemotherapy and radiotherapy might constitute the optimal treatment for this disease.

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Section: Discussionmentioning

confidence: 93%

Adult genitourinary sarcoma: Clinical characteristics and survival in a series of patients treated at a high‐volume institution

Wang

Tan

et al. 2017

Int J of Urology

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“…Although numerous studies have evaluated oncologic outcomes and predictors of long term prognosis in RPS, relatively few studies have assessed preoperative risk stratification and patient selection for surgical intervention. To date, previous publications of the surgical management of RPS have focused on the role of contiguous organ resection and pain, lower limb impairment, and impaired renal function [16, 21]. However, these studies have not significantly addressed the impact of physiological reserve and/or frailty on surgical outcomes, and this topic is increasingly important as our population ages with a concomitant growing incidence of cancer.…”

Section: Discussionmentioning

confidence: 99%

The modified frailty index to predict morbidity and mortality for retroperitoneal sarcoma resections

Park

Bateni

Bold

et al. 2017

Journal of Surgical Research

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Introduction The modified frailty index (mFI) is an important method to risk-stratify surgical patients and has been validated for general surgery and selected surgical subspecialties. However, there are currently no data assessing the efficacy of the mFI to predict acute morbidity and mortality in patients undergoing surgery for retroperitoneal sarcoma (RPS). Methods Using the American College of Surgeons’ National Surgical Quality Improvement Program from 2007 to 2012, we performed a retrospective analysis of patients with a diagnosis of primary malignant retroperitoneal neoplasm who underwent surgical resection. The mFI was calculated according to standard published methods. Univariate and multivariate statistical analyses including χ2 and logistic regression were utilized to identify predictors of 30-day overall morbidity, 30-day severe morbidity (Clavien III/IV), and 30-day mortality. Results We identified 846 patients with the diagnosis of primary malignant retroperitoneal neoplasm who underwent surgical resection. The distribution mFI scores was 0 (48.5%) or 1 (36.3%), with only 4.5% of patients presenting with a score ≥3. Rates of 30-day overall morbidity, serious morbidity, and mortality were 22.6%, 12.9%, and 1.2%, respectively. Only selected mFI scores were associated with serious morbidity and overall morbidity on multivariate analysis (p<0.05), and mFI did not predict 30-day mortality (p>0.05). Conclusion Our data demonstrate that the majority of patients undergoing RPS resections have few, if any, comorbidities. The mFI was a limited predictor of overall and serious complications and was not a significant predictor of mortality. Better discriminators of preoperative risk stratification may be needed for this patient population.

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“…[22][23][24][25][26] This questionnaire has also been used in the study of SRS-induced vertebral fractures, metastatic bone disease, and sarcoma resections. [27][28][29] Patients rate their worst, current, and average pain at the time of BPI collection (each ranging from 0 to 10) at the treatment site of interest. 30 ''Current'' pain at the time of BPI collection during clinical follow-up was used to evaluate pain relief and symptomatic failure after SRS.…”

Section: Methodsmentioning

confidence: 99%

Stereotactic Radiosurgery for the Treatment of Primary and Metastatic Spinal Sarcomas

Miller

Balagamwala

Angelov

et al. 2016

Technol Cancer Res Treat

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Purpose: Despite advancements in local and systemic therapy, metastasis remains common in the natural history of sarcomas. Unfortunately, such metastases are the most significant source of morbidity and mortality in this heterogeneous disease. As a classically radioresistant histology, stereotactic radiosurgery has emerged to control spinal sarcomas and provide palliation. However, there is a lack of data regarding pain relief and relapse following stereotactic radiosurgery. Methods: We queried a retrospective institutional database of patients who underwent spine stereotactic radiosurgery for primary and metastatic sarcomas. The primary outcome was pain relief following stereotactic radiosurgery. Secondary outcomes included progression of pain, radiographic failure, and development of toxicities following treatment. Results: Forty treatment sites were eligible for inclusion; the median prescription dose was 16 Gy in a single fraction. Median time to radiographic failure was 14 months. At 6 and 12 months, radiographic control was 63% and 51%, respectively. Among patients presenting with pain, median time to pain relief was 1 month. Actuarial pain relief at 6 months was 82%. Median time to pain progression was 10 months; at 12 months, actuarial pain progression was 51%. Following multivariate analysis, presence of neurologic deficit at consult (hazard ratio: 2.48, P < .01) and presence of extraspinal bone metastases (hazard ratio: 2.83, P < .01) were associated with pain relief. Greater pain at consult (hazard ratio: 1.92, P < .01), prior radiotherapy (hazard ratio: 4.65, P ¼ .02), and greater number of irradiated vertebral levels were associated with pain progression. Conclusions: Local treatment of spinal sarcomas has remained a challenge for decades, with poor rates of local control and limited pain relief following conventional radiotherapy. In this series, pain relief was achieved in 82% of treatments at 6 months, with half of patients experiencing pain progression by 12 months. Given minimal toxicity and suboptimal pain control at 12 months, dose escalation beyond 16 Gy is warranted.

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Long-term morbidity after multivisceral resection for retroperitoneal sarcoma

Abstract: Severe chronic pain and lower limb motor impairment after multivisceral resection for retroperitoneal sarcomas are rare. Long-term renal function is not significantly impaired when nephrectomy is performed.

Cited by 48 publications

References 26 publications

Adult genitourinary sarcoma: Clinical characteristics and survival in a series of patients treated at a high‐volume institution

Adult genitourinary sarcoma: Clinical characteristics and survival in a series of patients treated at a high‐volume institution

The modified frailty index to predict morbidity and mortality for retroperitoneal sarcoma resections

Stereotactic Radiosurgery for the Treatment of Primary and Metastatic Spinal Sarcomas

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