Retroperitoneal Sarcoma: Is It Time to Change the Surgical Policy?

Mussi, Chiara; Colombo, Piergiuseppe; Bertuzzi, Alexia; Coladonato, Massimiliano; Bagnoli, Pietro; Secondino, Simona; Navarria, Pierina; Morenghi, Emanuela; Santoro, Armando; Quagliuolo, Vittorio

doi:10.1245/s10434-011-1742-z

Cited by 81 publications

(51 citation statements)

References 20 publications

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“…2,3 Mussi et al add new evidence to support the need to systematically offer such an approach to all patients affected by primary RPS. 1 They have found that 60% of resected adjacent organs were microscopically infiltrated by the tumor. Indeed, their surgical policy has changed during the years.…”

Section: Alessandro Gronchi: Extended Surgery Is Critical To Improve mentioning

confidence: 99%

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Surgery in Retroperitoneal Soft Tissue Sarcoma: A Call for a Consensus Between Europe and North America

Gronchi

Pollock

2011

Ann Surg Oncol

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Section: Alessandro Gronchi: Extended Surgery Is Critical To Improve mentioning

confidence: 99%

“…The article by Mussi et al lends credence to several alternative perspectives. 1 We would like to offer the reader these different views for consideration and make a suggestion regarding how to arrive at a consensus.…”

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confidence: 99%

Surgery in Retroperitoneal Soft Tissue Sarcoma: A Call for a Consensus Between Europe and North America

Gronchi

Pollock

2011

Ann Surg Oncol

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“…Mussi et al 2 further reported a difference according to histologic subtype. The infiltrative pattern was more often observed in leiomyosarcoma and non-lipogenic tumors, whereas the expansive pattern was more often observed in liposarcoma.…”

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confidence: 93%

“…1). Mussi et al 2 also reported on HOI after extensive serial sections of the sarcoma and involved viscera had been performed. They defined visceral involvement by tumor as two major types: (1) the infiltrative type, in which the visceral structure is not embedded by the tumor but has clear, either focal or diffuse, infiltration by nests or single cells of normal renal cortex, hilar vessels, tunica muscularis of the bowel and the ureter, psoas muscle, pancreas, adrenal gland, liver, spleen, and the like, and (2) the pushing type (expansive), in which the organ is totally or partially embedded in tumor with ill-defined borders but no microscopic evidence of infiltration (i.e., invasion of perirenal adipose tissue by well-differentiated liposarcoma (WDLPS) without infiltration of the cortex).…”

mentioning

confidence: 99%

“…The growth pattern found in liposarcomas is more often a pushing type (expansive), in which the surrounding viscera/structure may be totally or partially embedded in tumor with illdefined borders, but without microscopic evidence of organ infiltration. 2 Although organ infiltration may not be evident, surgical resection of these adjacent uninvolved organs will provide a better quality of margin, whereas attempted dissection of an embedded organ from the tumor surface risks leaving microscopic residual tumor and compromising local control.…”

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confidence: 99%

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Adjacent, Adherent, Invaded: A Spectrum of Biologic Aggressiveness Rather Than a Rationale for Selecting Organ Resection in Surgery of Primary Retroperitoneal Sarcomas

2017

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Complete surgical resection of retroperitoneal sarcoma (RPS) remains the only potential curative treatment. The surgical strategy to achieve this optimal and most appropriate resection for each patient still creates some contention and controversy. Most contentious in this debate is the approach to the organs and structures neighboring a retroperitoneal sarcoma, with surgical strategy covering a spectrum from a conservative approach of organ-preserving and simple excision of the tumor alone to resection of the tumor and contiguous organs only when evidence of direct involvement exists to liberal multivisceral compartmental or extended resection of contiguous organs even if uninvolved. In the future, as more information is collected in a standardized and prospective fashion from specialist sarcoma units, this debate should evolve to define the most appropriate and personalized strategy, including extent of surgery, for each patient based on all available patient and prognostic factors.In this issue of Annals of Surgical Oncology, the group from Dana-Farber/Brigham and Women's Cancer Centre 1 report their experience of selective organ resection for primary retroperitoneal sarcomas, with the objective not to define the appropriate approach to surgical resection, but rather to examine the rate and rationale for organ resection and the rate of histopathologic organ infiltration (HOI) according to histologic subtype. In this elegant retrospective study, Fairweather et al. propose a six-tier system for classifying the rationale for organ resection.The rationale for organ resection was determined by reviewing the historic description of the procedure from the operative report. In this study, HOI is defined as infiltration of organ parenchyma or vessel wall by tumor cells. Organs that appeared to be inseparable from tumor were considered adherent. In 99 patients, at least one organ was resected, and the rationales for organ resection most often reported were tumor adherence, organ encasement, involved end-organ vasculature, and suspected invasion or tumor origin.This study has some limitations. First, the retrospective nature of the study makes it difficult to obtain a clear and accurate rationale from historic operative reports of organ resection. A patient selection bias existed regarding organ resection (e.g., influenced by age and comorbidities of the patient, surgical aggressiveness of the surgeon) and the degree of intraoperative subjectivity when a decision was made regarding the presence of a visible dissection plane or whether organs were adjacent or adherent to tumor. The study also does not include preoperative radiologic analysis, which should also contribute to the surgeon's decisionmaking process around the necessity for organ resection.The study lacked a standard for specimen processing, margin sampling, and characterization and definition of organ invasion. Consequently, the definition of HOI was not inclusive of tumors adherent to organs, which perhaps involved perivisceral/capsular invasion but not nece...

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