Skip to main content
SpringerLink
Log in

Severe Postoperative Complications are Associated with Impaired Survival in Primary but not in Recurrent Retroperitoneal Sarcoma

  • Sarcoma
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Retroperitoneal sarcoma (RPS) surgery entails multivisceral resection, which may cause postoperative complications. We assessed the effects of complications on survival to identify their predisposing factors in primary (PRPS) and recurrent (RRPS) RPS.

Methods

We retrospectively analyzed our institutional database. Severe postoperative complications (SC) were defined as Clavien-Dindo classification ≥ 3. Predisposing factors for complications were investigated, as was their effect on long-term outcomes.

Results

In total, 154 RPS resections (78 PRPS and 76 RRPS) performed between January 2008 and December 2018 were included. Neoadjuvant chemotherapy and multifocal tumors were more common in RRPS than PRPS (34.2% vs. 11.3%, P = 0.001 and 42.1% vs. 10.3%, P < 0.001, respectively). Although surgical extent in RRPS was limited compared with PRPS (weighted organ score 1 vs. 2, P = 0.01; transfusion requirement 23.6% vs. 35.8%, P = 0.04), SC and mortality rates were comparable. SC rates were 30.1% and 35.5% for PRPS and RRPS, respectively. NACT rate tended to be higher in PRPS patients with SC (20.8% vs. 7.4%, P = 0.09), whereas weighted organ score and transfusion requirement were increased in RRPS patients with SC (2 vs. 1, P = 0.01; 40.7% vs. 14.3%, P = 0.009, respectively). PRPS patients with SC had decreased overall survival (35 months, 95% confidence interval [CI] 12.2–57.7) compared with those without SC (90 months, 95% CI 71.4–108.5, P = 0.01).

Conclusions

Postoperative complications are associated with impaired outcomes in PRPS but not in RRPS. The negative effects of complications on outcomes should be factored to perioperative management.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Schaefer IM, Fletcher CDM. Recent advances in the diagnosis of soft tissue tumours. Pathology. 2018;50(1):37–48.

    Article  Google Scholar 

  2. Constantinidou A, Jones RL. Systemic therapy in retroperitoneal sarcoma management. J Surg Oncol. 2018;117(1):87–92.

    Article  Google Scholar 

  3. Haas RL, Baldini EH, Chung PW, van Coevorden F, DeLaney TF. Radiation therapy in retroperitoneal sarcoma management. J Surg Oncol. 2018;117(1):93–8.

    Article  Google Scholar 

  4. 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(1):31–7.

    Article  Google Scholar 

  5. 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(1):24–30.

    Article  Google Scholar 

  6. Fairweather M, Wang J, Jo VY, Baldini EH, Bertagnolli MM, Raut CP. Incidence and adverse prognostic implications of histopathologic organ invasion in primary retroperitoneal Sarcoma. J Am Coll Surg. 2017;224(5):876–83.

    Article  Google Scholar 

  7. Fairweather M, Wang J, Jo VY, Baldini EH, Bertagnolli MM, Raut CP. Surgical management of primary retroperitoneal sarcomas: rationale for selective organ resection. Ann Surg Oncol. 2018;25(1):98–106.

    Article  Google Scholar 

  8. Bonvalot S, Miceli R, Berselli M, et al. Aggressive surgery in retroperitoneal soft tissue sarcoma carried out at high-volume centers is safe and is associated with improved local control. Ann Surg Oncol. 2010;17(6):1507–14.

    Article  Google Scholar 

  9. MacNeill AJ, Gronchi A, Miceli R, et al. Postoperative Morbidity after radical resection of primary retroperitoneal sarcoma: a report from the transatlantic RPS working group. Ann Surg. 2018;267(5):959–64.

    Article  Google Scholar 

  10. Artinyan A, Orcutt ST, Anaya DA, Richardson P, Chen GJ, Berger DH. Infectious postoperative complications decrease long-term survival in patients undergoing curative surgery for colorectal cancer: a study of 12,075 patients. Ann Surg. 2015;261(3):497–505.

    Article  Google Scholar 

  11. Nathan H, Yin H, Wong SL. Postoperative complications and long-term survival after complex cancer resection. Ann Surg Oncol. 2017;24(3):638–44.

    Article  Google Scholar 

  12. Saeki H, Tsutsumi S, Tajiri H, et al. Prognostic significance of postoperative complications after curative resection for patients with esophageal squamous cell carcinoma. Ann Surg. 2017;265(3):527–33.

    Article  Google Scholar 

  13. Hayashi T, Yoshikawa T, Aoyama T, et al. Impact of infectious complications on gastric cancer recurrence. Gastric Cancer. 2015;18(2):368–74.

    Article  Google Scholar 

  14. Hiller JG, Perry NJ, Poulogiannis G, Riedel B, Sloan EK. Perioperative events influence cancer recurrence risk after surgery. Nat Rev Clin Oncol. 2018;15(4):205–18.

    Article  Google Scholar 

  15. Raut CP, Callegaro D, Miceli R, et al. Predicting survival in patients undergoing resection for locally recurrent retroperitoneal sarcoma: a study and novel nomogram from TARPSWG. Clin Cancer Res. 2019;25(8):2664–71.

    Article  Google Scholar 

  16. Gronchi A, Strauss DC, Miceli R, et al. Variability in patterns of recurrence after resection of primary retroperitoneal sarcoma (RPS): a report on 1007 patients from the multi-institutional Collaborative RPS Working Group. Ann Surg. 2016;263(5):1002–9.

    Article  Google Scholar 

  17. Nizri E, Fiore M, Colombo C, et al. Completion surgery of residual disease after primary inadequate surgery of retroperitoneal sarcomas can salvage a selected subgroup of patients: a propensity score analysis. J Surg Oncol. 2019;119(3):318–23.

    PubMed  Google Scholar 

  18. Blay JY, Honore C, Stoeckle E, et al. Surgery in reference centers improves survival of sarcoma patients: a nationwide study. Ann Oncol. 2019;30(8):1407.

    Article  Google Scholar 

  19. Coindre JM. Grading of soft tissue sarcomas: review and update. Arch Pathol Lab Med. Oct 2006;130(10):1448–53.

    Article  Google Scholar 

  20. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.

    Article  Google Scholar 

  21. Smith HG, Panchalingam D, Hannay JA, et al. Outcome following resection of retroperitoneal sarcoma. Br J Surg. 2015;102(13):1698–709.

    Article  CAS  Google Scholar 

  22. Pasquali S, Vohra R, Tsimopoulou I, Vijayan D, Gourevitch D, Desai A. Outcomes following extended surgery for retroperitoneal sarcomas: results from a UK Referral Centre. Ann Surg Oncol. 2015;22(11):3550–6.

    Article  Google Scholar 

  23. van Houdt WJ, Raut CP, Bonvalot S, Swallow CJ, Haas R, Gronchi A. New research strategies in retroperitoneal sarcoma. The case of TARPSWG, STRASS and RESAR: making progress through collaboration. Curr Opin Oncol. 2019;31(4):310–6.

  24. Labgaa I, Joliat GR, Kefleyesus A, et al. Is postoperative decrease of serum albumin an early predictor of complications after major abdominal surgery? A prospective cohort study in a European centre. BMJ Open. 2017;7(4):e013966.

    Article  Google Scholar 

  25. Mantziari S, Hubner M, Coti-Bertrand P, Pralong F, Demartines N, Schafer M. A novel approach to major surgery: tracking its pathophysiologic footprints. World J Surg. 2015;39(11):2641–51.

    Article  Google Scholar 

  26. Nicoli F, Saleh DB, Baljer B, et al. Intraoperative near-infrared fluorescence (NIR) imaging with indocyanine green (ICG) can identify bone and soft tissue sarcomas which may provide guidance for oncological resection. Ann Surg. Mar 27 2020.

Download references

Author information

Authors and Affiliations

  1. Surgical Oncology Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel

    Eran Nizri MD, Yael Netanyahu BSc, Fabian Gerstenhaber MD, Guy Lahat MD & Joseph M. Klausner MD

  2. Institute of Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel

    Sivan Shamai MD & Ofer Merimsky MD

  3. Institute of Pathology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel

    Osnat Sher MD

  4. Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

    Eran Nizri MD, Yael Netanyahu BSc, Fabian Gerstenhaber MD, Ofer Merimsky MD, Guy Lahat MD & Joseph M. Klausner MD

Authors
  1. Eran Nizri MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yael Netanyahu BSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fabian Gerstenhaber MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sivan Shamai MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Osnat Sher MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ofer Merimsky MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Guy Lahat MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Joseph M. Klausner MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Eran Nizri MD.

Ethics declarations

Disclosure

The authors declare no competing interests regarding this manuscript.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 17 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nizri, E., Netanyahu, Y., Gerstenhaber, F. et al. Severe Postoperative Complications are Associated with Impaired Survival in Primary but not in Recurrent Retroperitoneal Sarcoma. Ann Surg Oncol 28, 2693–2699 (2021). https://doi.org/10.1245/s10434-020-09179-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-020-09179-x

Search

Navigation