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

Gronchi, Alessandro; Pollock, Raphael E.

doi:10.1245/s10434-011-1746-8

Cited by 40 publications

(20 citation statements)

References 19 publications

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“…The issue is contentious 16–19 and has spurred vigorous point and counterpoint discussion. 20–23 Set against this context, the work presented here represents 30 years of a uniform operative approach to resection of retroperitoneal sarcomas, namely resection with the intent of obtaining negative microscopic margins, without resection of adjacent but uninvolved organs. This approach has been combined with low rates of radiation and chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

Histology-based Classification Predicts Pattern of Recurrence and Improves Risk Stratification in Primary Retroperitoneal Sarcoma

et al. 2016

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Objective To determine the prognostic significance of histologic type/subtype in a large series of patients with primary resected retroperitoneal sarcoma. Summary Background Data The histologic diversity and rarity of retroperitoneal sarcoma has hampered the ability to predict patient outcome. Methods From a single-institution, prospective database, 675 patients treated surgically for primary, non-metastatic retroperitoneal sarcoma during 1982–2010 were identified and histologic type/subtype was reviewed. Clinicopathologic variables were analyzed for association with disease-specific death (DSD), local recurrence (LR), and distant recurrence (DR). Results Median follow-up for survivors was 7.5 years. The predominant histologies were well-differentiated liposarcoma, dedifferentiated liposarcoma, and leiomyosarcoma. Five-year cumulative incidence of DSD was 31%, and factors independently associated with DSD were R2 resection, resection of ≥3 contiguous organs, and histologic type. Five-year cumulative incidence for LR was 39% and for DR was 24%. R1 resection, age, tumor size, and histologic type were independently associated with LR; size, resection of ≥3 organs, and histologic type were independently associated with DR. Liposarcoma and leiomyosarcoma were associated with late recurrence and DSD (as long as 15 years from diagnosis). For solitary fibrous tumor, local recurrence was uncommon (<10%), but early distant recurrence was common (36% at 5 years). Nomograms were developed to predict DSD, LR, and DR. Conclusions Histologic type/subtype is the most important independent predictor of DSD, LR, and DR in primary retroperitoneal sarcoma. Histology predicts the pattern and incidence of LR and DR and will aid in more accurate patient counseling and selection of patients for adjuvant therapy trials.

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Section: Discussionmentioning

confidence: 99%

Histology-based Classification Predicts Pattern of Recurrence and Improves Risk Stratification in Primary Retroperitoneal Sarcoma

et al. 2016

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confidence: 99%

“…4,5 It seeks to do so given the excellent local recurrence rates achieved by these highvolume surgeons who routinely perform compartmental resection for primary retroperitoneal sarcoma. The basis for their argument that routine extended resection should be performed lies in retrospective analyses of tumors treated at the INT during a period when extended resection was routine (2002-2011) versus those managed prior to 2002, and a series of 385 retroperitoneal sarcomas resected at IGR and retrospectively determined to have undergone compartmental (extended) resection compared with simple excision.…”

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confidence: 99%

Extended Surgical Resection and Histology in Retroperitoneal Sarcoma

Crago

2014

Ann Surg Oncol

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While several decades ago soft tissue sarcoma was often managed as one disease, we now recognize that sarcoma is an umbrella term encompassing almost 100 different pathologies, each characterized by unique genetic aberrations. In many ways, the field of sarcoma biology is on the cutting edge of personalized medicine; we routinely use histologic and molecular information to individualize management algorithms. In this issue of Annals of Surgical Oncology, Gronchi et al. present data collected over a 10-year period, and describing outcomes after resection of primary retroperitoneal sarcomas at the Instituto Nazionale Tumori (INT) in Milan and the Institute Gustave Roussy (IGR) in Paris. The study delineates rates of local and distal recurrence as they associate with histology. The results bring up numerous questions regarding our selection of patients for surgery and adjuvant therapy, as well as the manner in which we design and interpret clinical trials seeking to optimize management of retroperitoneal sarcomas.For example, the results presented by Dr Gronchi and colleagues demonstrate that retroperitoneal leiomyosarcoma has a high propensity for distal recurrence (55 % of patients in this series with 44 months' follow-up). Very few (5 %) were observed to have local recurrence without distant recurrence. A similar rate of distal recurrence-43 % at 5 years-was reported by Gladdy et al. 1 The rate continued to climb over time to 52 % at 10 years after surgery. Data of this nature have significant implications and can alter our approach to retroperitoneal leiomyosarcoma. A 40-50 % distal rate of metastasis is similar to that observed for large, high-grade extremity tumors.2 Patients with these lesions are frequently considered for neoadjuvant/adjuvant chemotherapy. Perhaps patients with retroperitoneal leiomyosarcomas should be considered for similar treatment. Similarly, if risk of local recurrence without distal disease is as low as 5 %, then this subgroup has little potential to benefit from neoadjuvant radiation. In fact, one could argue that inclusion of leiomyosarcoma patients in the ongoing EORTC phase III STRASS trial, which examines the role of neoadjuvant radiation, will compromise the power of a study in which the primary endpoint is abdominal recurrence-free survival. 3There are limitations to this study. Follow-up is short and, in some histologic subgroups, fewer than ten patients remain to be analyzed 5 years after surgery. Some potentially interesting points are not reported (e.g. do concurrent local and distal recurrences occur in dedifferentiated liposarcoma or leiomyosarcoma?), and it is arguable that patients undergoing R2 resection should have been excluded from analyses. However, in addition to the description of leiomyosarcoma outcomes discussed above, many other important points are made regarding the role of biology in predicting outcome after resection of retroperitoneal sarcomas. Well-differentiated liposarcomas do not metastasize and, when removed by an experienced surgeon, rates of local ...

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“…In retroperitoneal sarcoma, 60% of resected adjacent organs are microscopically infiltrated by the tumor. Because the histological grade of aggressiveness is the major outcome prognosticator and leiomyosarcomas metastasize avidly and rapidly, an initial extended resection involving all organs adjacent to the tumor gives a good possibility of local control and improved outcome 13 . In all previous cases, the tumors originated in the upper to middle ovarian vein, and existed near the inferior vena cava.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and management of leiomyosarcoma arising from ovarian vein: Case report and literature review

Tsuyoshi

Yoshida

Kurokawa

et al. 2012

J of Obstet and Gynaecol

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Primary leiomyosarcomas arising from the ovarian vein are extremely rare and are associated with high morbidity. A 49-year-old nulliparous woman presented with a left lower abdominal mass. Although extremely rare, the radiological appearance is able to preoperatively identify malignant retroperitoneal masses, such as leiomyosarcomas originating from the ovarian vein; thus, the patient underwent a simple total excision of the mass-adjacent organs, as well as complete resection of the uterus, bilateral adnexae and the left ovarian vein. Adjuvant postoperative combination chemotherapy with gemcitabine and docetaxel was administered. At 22 months, she had no recurrence or metastasis. Delayed diagnosis and high metastatic potentiality are associated with the high morbidity of vascular leiomyosarcomas. The preoperative radiological appearance is useful for early diagnosis, and radical treatment with adjuvant chemotherapy consisting of gemcitabine and docetaxel may improve the poor prognosis of patients with leiomyosarcoma arising from the ovarian vein.

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

Cited by 40 publications

References 19 publications

Histology-based Classification Predicts Pattern of Recurrence and Improves Risk Stratification in Primary Retroperitoneal Sarcoma

Histology-based Classification Predicts Pattern of Recurrence and Improves Risk Stratification in Primary Retroperitoneal Sarcoma

Extended Surgical Resection and Histology in Retroperitoneal Sarcoma

Diagnosis and management of leiomyosarcoma arising from ovarian vein: Case report and literature review

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