Recurrent Retroperitoneal Sarcoma: Impact of Biology and Therapy on Outcomes

Grobmyer, Stephen R.; Wilson, Jason P.; Apel, Brooke; Knapik, Jacquelyn A.; Bell, Walter C.; Kim, Tad; Bland, Kirby I.; Copeland, Edward M.; Hochwald, Steven N.; Heslin, Martin J.

doi:10.1016/j.jamcollsurg.2009.12.024

Cited by 61 publications

(75 citation statements)

References 34 publications

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“…5,6,15 However, currently available evidence for recurrent RP sarcomas supporting salvage resection generally lacks detailed histology-specific analyses, which make it difficult to apply those data to patients with recurrent RP WDLPS. 7–9,11,16–18 The survival impact of salvage surgery must differ between histologic subtypes, but no previous study included interaction (effect modification) terms in multivariable models, or they were underpowered to do so. Park et al from Memorial Sloan Kettering Cancer Center reported a study of 105 patients with locally recurrent RP liposarcomas (48 WDLPS, 49 de-differentiated, 4 myxoid, and 3 round cell liposarcomas), among whom 61 patients underwent salvage surgery; they showed that local recurrent tumor growth rates of less than 0.9 cm/month were associated with longer OS and DFS.…”

Section: Discussionmentioning

confidence: 99%

Salvage Surgery for Recurrent Retroperitoneal Well-Differentiated Liposarcoma: Early Reoperation may not Provide Benefit

et al. 2018

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Purpose Current evidence regarding salvage resection for recurrent retroperitoneal (RP) sarcomas generally lacks detailed histology-specific analyses, but the aggressiveness of these tumors varies widely by histology. We investigated associations between timing and extent of salvage surgery and survival outcomes in patients with recurrent RP well-differentiated liposarcoma (WDLPS). Methods The University of Texas MD Anderson Cancer Center Surgical Oncology sarcoma database was reviewed to identify patients with RP WDLPS who underwent surgical resection for 1st recurrent disease (salvage surgery) in 1995–2015. Medical records were retrospectively reviewed to identify factors associated with overall survival (OS) and disease-free survival (DFS). Results We identified 52 patients who underwent salvage surgery for RP WDLPS for 1st local recurrence; 28 (54%) underwent salvage surgery within 6 months after recurrence. Concomitant organ resections were performed in 32 (62%) patients, 4 (13%) of whom had pathologic invasion of resected organs. After R0/R1 resections (n=45), 38 (84%) experienced a 2nd local recurrence. Multivariable analyses revealed that organ invasion at the primary surgery (HR 13.08; p=0.005) and disease-free interval <1 year (HR 3.64; p=0.044) were associated with shorter OS. Recurrence-to-salvage interval <6 months was associated with shorter DFS (HR 2.18; p=0.025). Concomitant organ resection was associated with a longer hospital stay, ≥14 days (OR 21.58; p=0.007). Conclusions Early salvage surgery may not always be the best approach for recurrent RP WDLPS patients. Since organ invasion is rare among recurrent RP WDLPS patients and concomitant organ resection is associated with a longer hospital stay, preservation of uninvolved organs should be considered.

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Section: Discussionmentioning

confidence: 99%

Salvage Surgery for Recurrent Retroperitoneal Well-Differentiated Liposarcoma: Early Reoperation may not Provide Benefit

et al. 2018

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“…The recent higher rates of complete resection for recurrent disease may reflect improved surgical technique, a more aggressive approach to resection of all retroperitoneal tumors, or improved patient selection. Complete resection should always be considered for recurrent disease as it is critical for improved survival [25] and in fact, may even result in comparable survival to patients after complete resection of primary disease [26]. …”

Section: Discussionmentioning

confidence: 99%

Complete and safe resection of challenging retroperitoneal tumors: anticipation of multi-organ and major vascular resection and use of adjunct procedures

et al. 2011

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BackgroundRetroperitoneal tumors are often massive and can involve adjacent organs and/or vital structures, making them difficult to resect. Completeness of resection is within the surgeon's control and critical for long-term survival, particularly for malignant disease. Few studies directly address strategies for complete and safe resection of challenging retroperitoneal tumors.MethodsFifty-six patients representing 63 cases of primary or recurrent retroperitoneal tumor resection between 2004-2009 were identified and a retrospective chart review was performed. Rates of complete resection, use of adjunct procedures, and perioperative complications were recorded.ResultsIn 95% of cases, complete resection was achieved. Fifty-eight percent of these cases required en bloc multi-organ resection, and 8% required major vascular resection. Complete resection rates were higher for primary versus recurrent disease. Adjunct procedures (ureteral stents, femoral nerve monitoring, posterior laminotomy, etc.) were used in 54% of cases. Major postoperative complications occurred in 16% of cases, and one patient died (2% mortality).ConclusionsComplete resection of challenging retroperitoneal tumors is feasible and can be done safely with important pre- and intraoperative considerations in mind.

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“…The factors that influence the rates and pattern of failure of all RPS histologic subtypes can be attributed to patient characteristics, tumor features, and surgical variables; however, few studies specifically address RPLPS . Even fewer studies address which of these factors are associated with multiple recurrent disease . In this section, we will review the key factors that impact first and subsequent RPLPS local recurrences.…”

Section: Factors Influencing Rates and Pattern Of Failurementioning

confidence: 99%

Multiply recurrent retroperitoneal liposarcoma

Bagaria

Gabriel

Mann³

2017

Journal of Surgical Oncology

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Retroperitoneal liposarcomas (RPLPS) are rare tumors that represent at least 50% of all retroperitoneal sarcomas. Surgical resection remains the standard of care. Unfortunately, many RPLPS patients will develop a local recurrence and subsequently die in the absence of distant metastasis. This review outlines the factors that predict local recurrence and influence the management of first and subsequent multiply recurrent RPLPS.

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Recurrent Retroperitoneal Sarcoma: Impact of Biology and Therapy on Outcomes

Cited by 61 publications

References 34 publications

Salvage Surgery for Recurrent Retroperitoneal Well-Differentiated Liposarcoma: Early Reoperation may not Provide Benefit

Salvage Surgery for Recurrent Retroperitoneal Well-Differentiated Liposarcoma: Early Reoperation may not Provide Benefit

Complete and safe resection of challenging retroperitoneal tumors: anticipation of multi-organ and major vascular resection and use of adjunct procedures

Multiply recurrent retroperitoneal liposarcoma

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