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

Abstract

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.

Single centre 30‐year experience in treating retroperitoneal liposarcomas

“…This is similar to rates reported previously (60%-84%) and supports the idea that the development of multifocal disease in the peritoneum renders the disease poorly controllable with repeat surgeries and early surgery may not be the best treatment strategy. 7,21 The histological grade of the tumor increased during a recurrence in 25% of the patients, in line with a previous report of 33% dedifferentiation rate observed in lipoma-like liposarcomas. 22 Histological grade was predictive of metastasis with grade 3 tumors having a 16-fold higher risk of developing metastases than Note: Tumor type (P < .01), grade (P < .01) resection margins (P < .01), age (P = .02), radiotherapy (P = .02), chemotherapy (P < .01), and metastases at the time of diagnosis (P < .01) were prognostic of disease-specific survival on univariate analysis.…”

Individualisierte multimodale Therapie retroperitonealer Weichteilsarkome

“…In den genannten Zentren erfolgen "selektive multiviszerale Resektionen" (SMVR). Sie konnten Daten zum OS und der LRR nachweisen, die mehrheitlich nicht wesentlich von den Studien abwichen, deren Autoren die SRKR propagieren [41,42]. Eine Ausnahme war die Studie von Tan et al vom MSKCC [3], die im Vergleich zu den anderen Studien mit einem 5-J-OS von 55 % und einer LRR von 45 % signifikant schlechtere Follow-up-Daten präsentier-▶ Tab.…”

Strategic Delay: Histology- and Biology-Driven Decision-Making in Recurrent Retroperitoneal Sarcoma

“…In this issue, the sarcoma group at the MD Anderson Cancer Center (MDACC) has tackled the important and challenging problem of well-differentiated liposarcoma (WD-LPS) of the retroperitoneum, as part of a series of recent contributions that explore approaches to retroperitoneal sarcoma (RPS) and outcomes at their institution. 1 In particular, Ikoma et al report the survival and re-recurrence rates after resection of recurrent WD-LPS of the retroperitoneum. Their results are a stark reminder of the serious impact that the diagnosis of primary RP WD-LPS has on patients' expectations for life and of the gravity of recurrence.…”

“…Thus, the paper by Ikoma et al adds a new dimension, focusing exclusively on WD-LPS. 1 This singular focus on recurrent WD-LPS of the retroperitoneum is noteworthy, and the information provided is immensely useful. This is the histologic subtype for which considerations about risk/benefit of salvage surgery is the most relevant, because these patients have the most extended survival, albeit with an extremely local high relapse rate following resection of first local recurrence (84% at a median follow-up time of 4.5 years in this series of 45 patients with an R 0 /R 1 resection).…”

“…Given the poor outcomes in the subgroup of patients who undergo resection of recurrent WD-LPS despite indicators of adverse biology, one must consider what other treatment options we can offer such patients. 1 There is ongoing controversy about the sensitivity of WD-LPS to radiation treatment, and many centers that employ preoperative XRT in the management of primary RPS would not consider WD-LPS to be an indication for this treatment. The radiation-associated toxicity that ensues when radiation is used in the postoperative setting will be encountered when patients with local recurrence are treated with XRT, narrowing the potential therapeutic window.…”