Primary and locally recurrent retroperitoneal soft-tissue sarcoma: Local control and survival

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Abstract

Aim

To evaluate local control for long-term prognosis in retroperitoneal soft-tissue sarcoma (primary tumors (PT) and local recurrence (LR)).

Methods

A total of 110 patients underwent surgery between 1988 and 2002. Prospectively gathered clinicopathological data were analyzed. Kaplan–Meier estimations and Cox regression analyses were performed.

Results

Resectability was 90%, being comparable for PT (n = 71) and LR (n = 39). Morbidity, mortality, blood loss, and operation time did not differ for PT or LR (24% vs. 31%, p = 0.41; 7.0% vs. 5.1%, p = 1.0; 1000 ml vs. 1500 ml, p = 0.17; 240 min vs. 255 min, p = 0.13). Hospitalization was comparable in both groups (median, 12 days (PT) and 13 days (LR)). Follow-up was 89 months (median, IQR 37–112 months). Local 3- and 5-year control rates after complete resection of PT were 66% and 59% (19% and 9% for LR, p < 0.001). The mean number of operations were 1.4 for PT and 2.4 for LR (p = 0.0047). The 5-year survival rates after complete resection were 51% for PT and 43% for LR (p = 0.39). The 5-year survival rates were 65%, 4%, and 0% for complete resection, incomplete resection, and exploration, respectively (p < 0.001). Multivariate analysis showed high-grade and blood loss with a poor prognosis.

Conclusions

Comparable resectability rates and perioperative outcome were observed for surgery of PT and LR. Consequent reoperation leads to respectable long-term survival rates after resection of LR. The prognosis in retroperitoneal sarcomas varies significantly according to resectability, grade and blood loss.

Introduction

Recently, it was shown that 77% of retroperitoneal sarcoma-related deaths were caused by local recurrence without concomitant metastasis.1 Local control is therefore essential in the treatment of patients with retroperitoneal sarcoma (RSTS). Surgery is the mainstay of treatment.2, 3 Effective adjuvant chemotherapy regimens remain to be identified and radiotherapy is limited because of the toxicity to adjacent normal structures.4 Due to the restricted number of clinical series and the lack of multicenter randomized trials the significance of the presentation status, primary vs. locally recurring RSTS, at first referral to a specialized center is still under discussion. How does local recurrence influence resectability, surgical risks, and the further course of the disease compared to primary tumor? A previous study showed that local recurrence is a predictive factor of disease-specific survival in RSTS.3 Locally recurrent RSTS was associated with poorer long-term survival after resection than after surgery for primary RSTS.3 In sarcomas of the extremities, however, detailed analysis showed that, after treatment, long-term survival rates are comparable for patients with primary and locally recurrent tumor.5 The aim of the present study was to examine the surgical outcome of patients with RSTS, focusing on the presentation status, primary vs. locally recurrent sarcoma, at primary referral to a specialized center. Immediate and long-term outcome were analyzed.

Section snippets

Patients

A total of 461 adult patients with soft tissue sarcoma underwent surgery, 110 of these patients (55 women and 55 men) (24%) for RSTS (Department of Surgery, University of Heidelberg, from January 1988 to August 2002). The median age was 55 years (interquartile range (IQR): 42–63 years). In all, 71 patients were referred for primary tumors (PT). Thirteen (18%) of these had undergone previous surgery elsewhere. Thirty-nine patients were referred with locally recurrent disease (LR): 18 with the

Resectability, blood loss, and hospitalization

Resection was performed in 99 patients. Resection was rendered complete in 50 patients with primary tumors. Twelve PT were partially resected and a further nine masses were explored and biopsied. Reasons for exploration without resection were peritoneal sarcomatosis (n = 5), extensive vascular involvement (mesenteric root, n = 3), and coagulopathy (n = 1).

Complete resection was achieved in the majority of the patients (Table 1). The other patients were either partially resected or rendered

Discussion

Among solid tumors, RSTS is the most regularly resected local recurrent tumor under curative intent. Although treatment of local recurrence is important, a detailed analysis in comparison to primary occurrence has not been undertaken in most studies.

Conclusion

We demonstrated the clinical significance of complete surgical resection in patients with primary and locally recurrent RPS. Patients who present with locally recurring tumor have an increased risk of experiencing further local tumor recurrence, but with a consequent reoperation policy a respectable long-term survival can be achieved.

Conflict of interest

The authors declare that there is no potential or actual personal, financial or political interest related to this article.

Acknowledgement

S.C. is supported by a fellowship from the National Council for Science and Technology (CONACYT), Mexico.

References (31)

  • J.M. Coindre et al.

    Reproducibility of a histopathologic grading system for adult soft tissue sarcoma

    Cancer

    (1986)
  • E.L. Kaplan et al.

    Non-parametric estimation from incomplete observations

    J Am Stat Assoc

    (1958)
  • D.R. Cox

    Regression models and life tables (with discussion)

    J R Stat Soc B

    (1972)
  • F.K. Storm et al.

    Diagnosis and management of retroperitoneal soft tissue sarcoma

    Ann Surg

    (1991)
  • T. Ferrario et al.

    Retroperitoneal sarcomas. grade and survival

    Arch Surg

    (2003)
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