Abstract
Background
Complete tumor resection is the mainstay of treatment for retroperitoneal sarcoma (RPS), but the size and quality of surgical margins for radical resection in RPS are unknown. They are believed to be pushing tumors, but recently, aggressive surgical policies leading to multivisceral resection have seemed to suggest better local control compared with simple tumor resection. We analyzed a single-institution series of RPS to provide information useful to surgical decision-making.
Methods
From 1996 to 2008, 77 patients referred to our institution underwent surgery for primary RPS. Thirty tumors were classified as liposarcoma, and 20 as leiomyosarcoma. Potential prognostic factors were tested retrospectively. Number and pathologic status of resected organs were assessed.
Results
151 organs were resected. Ninety-two were involved by the tumor (60.9%). Liposarcoma involved 48 of 77 organs resected for this histotype (62.3%). Infiltrative pattern was observed in 39/92 organs, and expansive pattern in 53/92 viscera. The infiltrative pattern was more often observed in leiomyosarcoma and non-lipogenic tumors. The expansive pattern was more often observed in liposarcoma. Psoas was the organ most often involved by infiltrative pattern (12/14); the kidney was the organ most often involved by expansive pattern (19/28). 80% of patients had at least one viscera infiltrated by the tumor.
Conclusions
This series, in which an aggressive surgical policy was adopted along with extensive pathologic sampling, shows that RPS has a high rate of viscera infiltration. This growth pattern is characteristic of well-differentiated liposarcoma too. These pathologic data should be considered when planning surgical strategy.
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References
Porter GA, Baxter NN, Pisters PWT. Retroperitoneal sarcoma: a population-based analysis of epidemiology, surgery and radiotherapy. Cancer. 2006;106:1610–6.
Lewis JJ, Leung D, Woodruff JM, et al. Retroperitoneal soft tissue sarcoma. Analysis of 500 patients treated and followed at a single institution. Ann Surg. 1998;228(3):355–65.
Stoeckle E, Coindre JM, Bonvalot S, et al. Prognostic factors in retroperitoneal sarcoma. A multivariate analysis of a series of 165 patients of the French Cancer Center Federation Sarcoma Group. Cancer. 2001;92(2):359–68.
Singer S, Corson JM, Demetri GD, et al. Prognostic factors predicting of survival for truncal and retroperitoneal soft tissue sarcoma. Ann Surg. 1995;221(2):185–95.
Mussi C, Collini P, Miceli R, et al. The prognostic impact of dedifferentiation in retroperitoneal liposarcoma: a series of surgically treated patients at a single institution. Cancer. 2008;113:1657–65.
Lahat G, Anaya DA, Wang X, et al. Resectable well-differentiated versus dedifferentiated liposarcomas: two different diseases possibly requiring different treatment approaches. Ann Surg Oncol. 2008;15:1585–93.
Gronchi A, Lo Vullo S, Fiore M, et al. Aggressive surgical policies in a retrospectively reviewed single-institution case series of retroperitoneal soft tissue sarcoma patients. J Clin Oncol. 2009;27:24–30.
Pisters PW. Resection of some—but not all—clinically uninvolved adjacent viscera as part of surgery for retroperitoneal soft tissue sarcoma. J Clin Oncol. 2009;27:6–8.
Bonvalot S, Rivoire M, Castaing M, et al. Primary retroperitoneal sarcomas: a multivariate analysis of surgical factors associated with local control. J Clin Oncol. 2009;27:31–7.
Casali PG, Jost L, Sleijfer S, et al. Soft tissue sarcomas: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol. 2008 (Suppl);19:ii89–ii93.
Raut CP, Pisters PWT. Retroperitoneal sarcomas; combined-modality treatment approaches. J Surg Oncol. 2006;94:81–7.
Van Doorn RC, Gallee MPW, Hart AAM, et al. Resectable retroperitoneal soft tissue sarcoma. The effect of extent of resection and post-operative radiation therapy on local tumor control. Cancer. 1994;73(3):637–42.
Sindelar WF, Kinsella TJ, Chen PW, et al. Intraoperative radiotherapy in retroperitoneal sarcomas. Final results of a prospective, randomized, clinical trial. Arch Surg. 1993;128:402–10.
Pisters PW, Ballo MT, Fenstermacher MJ, et al. Phase I trial of preoperative concurrent doxorubicin and radiation therapy, surgical resection and intraoperative electron beam radiation therapy for patients with localized retroperitoneal sarcoma. J Clin Oncol. 2003;21:3092–7.
Robertson JM, Sondak VK, Weiss SA, et al. Preoperative radiation therapy and iododeoxyuridine for large retroperitoneal sarcomas. Int J Radiat Oncol Biol Phys. 1995;31:87–92.
Jones JJ, Catton CN, O’Sullivan B et al. Initial results of a trial of preoperative external beam radiation therapy and postoperative brachytherapy for retroperitoneal sarcoma. Ann Surg Oncol. 2002;9:346–54.
Common Terminology Criteria for Adverse Events (CTCAE) v3.0 online instructions and guidelines. Available at: https://webapps.ctep.nci.nih.gov/webobjs/ctc/webhelp/welcome_to_ctcae.htm. Accesssed June 2010.
Enneking WP, Spainer SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop. 1980;153:106–20.
Brennan M, Alektiar KM, Maki RG. Soft tissue sarcoma. In: DeVita VT, Hellmann S, Rosenberg SA, eds. Cancer. Principles and practice of oncology. Philadelphia: Lippincott Williams & Wilkins; 2001. pp. 1841–91.
Gronchi A, Casali PG, Mariani L, et al. Status of surgical margins and prognosis in adult soft tissue sarcomas of the extremities: a series of patients treated at a single institution. J Clin Oncol. 2005;23:96–104.
Bonvalot S, Miceli R, Berselli M, et al. Aggressive surgery in retroperitoneal soft tissue sarcoma carried out at high-volume centres is safe and is associated with improved local control. Ann Surg Oncol. 2010;17:1507–14.
Mussi C, Ronellenfitsch U, Jakob J, et al. Post-imatinib surgery in advanced/metastatic GIST: is it worthwhile in all patients? Ann Oncol. 2010;21:403–8.
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Mussi, C., Colombo, P., Bertuzzi, A. et al. Retroperitoneal Sarcoma: Is It Time to Change the Surgical Policy?. Ann Surg Oncol 18, 2136–2142 (2011). https://doi.org/10.1245/s10434-011-1742-z
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DOI: https://doi.org/10.1245/s10434-011-1742-z