Retroperitoneal Sarcomas

Abstract

Background: The survival of patients with retroperitoneal sarcomas depends on the feasibility of complete resection and the grade of the tumor. Hypothesis: A high rate of complete resection, wide rather than local excision when feasible, and a policy of prompt reoperation for local recurrence all improve survival. Methods: A review of 130 consecutive patients with retroperitoneal soft tissue sarcomas (1977-2001). Results: The complete resectability rate was 95%, being 99% (78/79) for the primary tumors and 90% (46/51) for tumors referred with local recurrence. Local recurrence after complete resection occurred in 41% (32/79) of those with primary tumors and in 61% (31/51) of those referred with local recurrence (P=.06). The local recurrence rate was 63% after local excision and 39% after wide resection (P=.02). Of 83 patients with relapse, 37 (45%) were rendered surgically disease free. The estimated 5-year (10-year in parentheses) survival from the first surgery at our center was 65% (56%) for patients with primary tumors and 53% (34%) for patients referred with local recurrence (P=.23). For the primary tumors, the 5-and 10-year survival rates were 70% and60%,respectively,afterwideresectionand47%and39%, respectively, after local excision (P=.04). For the primary tumors,the5-yearsurvivalwas92%,54%,and48%forgrades I, II, and III, respectively (P=.02). For those referred with local recurrence, the figures were 76%, 45%, and 19% for grades I, II, and III, respectively (PϽ.001). Conclusions: A high resectability rate (95%) is possible in retroperitoneal sarcomas. The survival estimates are similar to those following resection of extremity soft tissue sarcomas given an effective reoperation policy for local recurrences. Wide resection lowers the local recurrence and improves survival significantly. Survival varies significantly according to the grade of the tumor.

Challenges in the Surgical Treatment of Retroperitoneal Sarcomas

“…The rate of complete resection has varied in the literature from 38 [10] to 74 % [12], with other reports falling in between [3][4][5]13], while the average complete respectability rate in a collective review was 53 % [2]. Ferrario et al [8] believe that the low respectability rate in the literature is due to the fact that the majority of patients with RPS are operated on in a supine position through a midline abdominal incision that does not take advantage of gravity for patients with upper quadrant or flank tumors.…”

“…These tumors have a well-earned reputation for local recurrence [3][4][5]. The prognosis of patients with RPS is generally poor, especially when assessed over long term [6][7][8][9]. Reported 5-year survival rates range between 12 and 70 % [10].…”

Retroperitoneal soft tissue sarcomas

“…[2][3][4][5][6][7][8][9][10] In many series, the quality of surgery was the only significant prognostic factor for survival; therefore, extensive surgery has been advocated strongly. [2][3][4][5][6][7][8][9][10] However, even in series that produced excellent rates of resection, the local recurrence rate remained high. This most likely is related to the difficulty of ensuring truly tumor free margins in retroperitoneal sarcomas, no matter how experienced the surgeon.…”

“…The prognosis of patients with STS generally is poor, especially when they are assessed over the long term. [2][3][4][5][6][7][8][9][10] The contribution of adjuvant chemotherapy to the treatment of adult patients with STS remains questionable, whereas radiation therapy in patients with retroperitoneal STS is either unfeasible or is affected strongly by anatomic constraints (mainly related to the presence of kidneys and small bowel). Therefore, the main therapeutic burden is placed on surgery.…”

“…Therefore, the main therapeutic burden is placed on surgery. [2][3][4][5][6][7][8][9][10] However, surgery alone is curative in only a relatively small number of patients. Available studies vary widely with regard to estimates of cured or long-term survivors, most likely depending on strong variations in the referral pattern of the various institutions.…”