Clinical characteristics and surgical outcomes of retroperitoneal tumors: a comprehensive data collection from multiple departments

  • Naoto Sassa
  • Yukihiro YokoyamaEmail author
  • Yoshihiro Nishida
  • Suguru Yamada
  • Hiroo Uchida
  • Hiroaki Kajiyama
  • Masato Nagino
  • Yasuhiro Kodera
  • Momokazu Gotoh
Original Article



There are only a limited number of comprehensive reports for retroperitoneal tumors (RPTs). The aim of this study was to perform an interdepartmental data collection for RPTs and to comprehensively clarify the clinical characteristics of this rare disease.


All patients who were diagnosed with RPT from January 2005 to July 2018 in a single institution were included. The analyzed factors included demographics, clinical features, treatment methods, pathological diagnosis, and prognosis.


A total of 422 patients (215 males and 207 females) with primary RPTs were identified. Biopsy for RPT was performed in 180 patients (43%). Among the 422 patients, 239 (57%) underwent surgery. The most common tissue origin was mesodermal (n = 99, 41%), followed by neurogenic (n = 54, 23%), extragonadal (n = 27, 11%), and metastatic tumors (n = 13, 5%). Among the 99 resected mesodermal tumors, the most common pathological subtypes were liposarcoma (n = 55, 56%) and leiomyosarcoma (n = 16, 16%). The long-term outcomes after surgery were analyzed in patients with intermediate and malignant sarcomas (including liposarcoma, leiomyosarcoma, and others combined, n = 71). The 3- and 5-year disease-free survival rates in the intermediate tumors were 68.2% and 54.2%, respectively, whereas those in the malignant tumors were 48.6% and 28.9%, respectively. The 3- and 5-year overall survival rates in the intermediate tumors were 100% and 94.1%, respectively, whereas those in the malignant tumors were 78.4% and 72.8%, respectively (p = 0.009).


The clinical manifestations of RPTs were extremely variable. Recurrence after repeating resection is commonly observed in patients with malignant retroperitoneal sarcoma.


Interdepartmental data collection Retroperitoneal sarcoma Repeating resection Retroperitoneum Clinical characteristics Sarcoma Recurrence 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest in the subject matter in this manuscript.

Supplementary material

10147_2020_1620_MOESM1_ESM.tif (87 kb)
Suppl Fig. 1 The number of patients according to the chief compliant at first visit (a) and laterality of the tumor (b) (TIF 87 kb)
10147_2020_1620_MOESM2_ESM.tif (90 kb)
Suppl Fig. 2 (a) Pie chart with overlap according to the modality used for the diagnosis, including computed tomography (CT), magnetic response imaging (MRI), and 18F-FDG-positron emission tomography (18F-FDG-PET). (b) Number of patients with retroperitoneal tumors according to the maximum size of the tumor at first diagnosis (TIF 91 kb)
10147_2020_1620_MOESM3_ESM.tif (75 kb)
Suppl Fig. 3 Flow chart of the postoperative outcomes in patients undergoing surgery for intermediate/malignant tumors (TIF 76 kb)


  1. 1.
    Osman S, Lehnert BE, Elojeimy S et al (2013) A comprehensive review of the retroperitoneal anatomy, neoplasms, and pattern of disease spread. Curr Probl Diagn Radiol 42(5):191–208CrossRefGoogle Scholar
  2. 2.
    Scali EP, Chandler TM, Heffernan EJ et al (2015) Primary retroperitoneal masses: what is the differential diagnosis? Abdom Imaging 40(6):1887–1903CrossRefGoogle Scholar
  3. 3.
    Ikoma N, Roland CL, Torres KE et al (2018) Concomitant organ resection does not improve outcomes in primary retroperitoneal well-differentiated liposarcoma: a retrospective cohort study at a major sarcoma center. J Surg Oncol 117(6):1188–1194CrossRefGoogle Scholar
  4. 4.
    Gronchi A, Miceli R, Allard MA et al (2015) Personalizing the approach to retroperitoneal soft tissue sarcoma: histology-specific patterns of failure and postrelapse outcome after primary extended resection. Ann Surg Oncol 22(5):1447–1454CrossRefGoogle Scholar
  5. 5.
    Macneill AJ, Miceli R, Strauss DC et al (2017) Post-relapse outcomes after primary extended resection of retroperitoneal sarcoma: a report from the Trans-Atlantic RPS Working Group. Cancer 123(11):1971–1978CrossRefGoogle Scholar
  6. 6.
    Keung EZ, Chiang YJ, Cormier JN et al (2018) Treatment at low-volume hospitals is associated with reduced short-term and long-term outcomes for patients with retroperitoneal sarcoma. Cancer 124(23):4495–4503CrossRefGoogle Scholar
  7. 7.
    Nazzani S, Preisser F, Bandini M et al (2018) Surgically treated retroperitoneal sarcoma: a population-based competing risks analysis. Eur Urol Oncol 1(4):346–351CrossRefGoogle Scholar
  8. 8.
    Liang SX, Howitt B, Blitz MJ et al (2015) Primary myxoid liposarcoma of the ovary in a postpartum female: a case report and review of literature. Int J Gynecol Pathol 34(3):298–302CrossRefGoogle Scholar
  9. 9.
    Li M, Li H, Du Y et al (2017) Combined anterior-posterior approach with enlarged sciatic foramen to remove sciatic notch dumbbell-shaped tumors. J Surg Oncol 115(4):384–389CrossRefGoogle Scholar
  10. 10.
    Gronchi A, Strauss DC, Miceli R et al (2016) 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 263(5):1002–1009CrossRefGoogle Scholar
  11. 11.
    Fletcher C, Bridge J, Hogendoorn P et al (2013) WHO classification of tumours of soft tisue and bone, 4th edn.Google Scholar
  12. 12.
    Goenka AH, Shah SN, Remer EM (2012) Imaging of the retroperitoneum. Radiol Clin North Am 50(2):333–355 (vii) CrossRefGoogle Scholar
  13. 13.
    Trans-Atlantic RPSWG (2015) Management of primary retroperitoneal sarcoma (RPS) in the adult: a consensus approach from the Trans-Atlantic RPS Working Group. Ann Surg Oncol 22(1):256–263CrossRefGoogle Scholar
  14. 14.
    Nishino M, Hayakawa K, Minami M et al (2003) Primary retroperitoneal neoplasms: CT and MR imaging findings with anatomic and pathologic diagnostic clues. Radiographics 23(1):45–57CrossRefGoogle Scholar
  15. 15.
    Almond LM, Tirotta F, Tattersall H et al (2019) Diagnostic accuracy of percutaneous biopsy in retroperitoneal sarcoma. Br J Surg 106(4):395–403CrossRefGoogle Scholar
  16. 16.
    Berger-Richardson D, Swallow CJ (2017) Needle tract seeding after percutaneous biopsy of sarcoma: risk/benefit considerations. Cancer 123(4):560–567CrossRefGoogle Scholar
  17. 17.
    Van Houdt WJ, Schrijver AM, Cohen-Hallaleh RB et al (2017) Needle tract seeding following core biopsies in retroperitoneal sarcoma. Eur J Surg Oncol 43(9):1740–1745CrossRefGoogle Scholar
  18. 18.
    Wilkinson MJ, Martin JL, Khan AA et al (2015) Percutaneous core needle biopsy in retroperitoneal sarcomas does not influence local recurrence or overall survival. Ann Surg Oncol 22(3):853–858CrossRefGoogle Scholar
  19. 19.
    Gronchi A, Miceli R, Shurell E et al (2013) Outcome prediction in primary resected retroperitoneal soft tissue sarcoma: histology-specific overall survival and disease-free survival nomograms built on major sarcoma center data sets. J Clin Oncol 31(13):1649–1655CrossRefGoogle Scholar
  20. 20.
    Toulmonde M, Bonvalot S, Ray-Coquard I et al (2014) Retroperitoneal sarcomas: patterns of care in advanced stages, prognostic factors and focus on main histological subtypes: a multicenter analysis of the French Sarcoma Group. Ann Oncol 25(3):730–734CrossRefGoogle Scholar
  21. 21.
    Casali PG, Abecassis N, Aro HT et al (2018) Soft tissue and visceral sarcomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 29((Supplement_4)):iv268–iv269CrossRefGoogle Scholar
  22. 22.
    Toulmonde M, Bonvalot S, Meeus P et al (2014) Retroperitoneal sarcomas: patterns of care at diagnosis, prognostic factors and focus on main histological subtypes: a multicenter analysis of the French Sarcoma Group. Ann Oncol 25(3):735–742CrossRefGoogle Scholar
  23. 23.
    Wilkinson KH, Ethun CG, Hembrook M et al (2019) Outcomes of elderly patients undergoing curative resection for retroperitoneal sarcomas: analysis from the US Sarcoma Collaborative. J Surg Res 233:154–162CrossRefGoogle Scholar

Copyright information

© Japan Society of Clinical Oncology 2020

Authors and Affiliations

  • Naoto Sassa
    • 1
  • Yukihiro Yokoyama
    • 2
    • 6
    Email author
  • Yoshihiro Nishida
    • 3
  • Suguru Yamada
    • 2
  • Hiroo Uchida
    • 4
  • Hiroaki Kajiyama
    • 5
  • Masato Nagino
    • 2
  • Yasuhiro Kodera
    • 2
  • Momokazu Gotoh
    • 1
  1. 1.Department of UrologyNagoya University Graduate School of MedicineNagoyaJapan
  2. 2.Department of Gastrointestinal SurgeryNagoya University Graduate School of MedicineNagoyaJapan
  3. 3.Department of Rehabilitation MedicineNagoya University Graduate School of MedicineNagoyaJapan
  4. 4.Department of Pediatric SurgeryNagoya University Graduate School of MedicineNagoyaJapan
  5. 5.Department of Obstetrics and GynecologyNagoya University Graduate School of MedicineNagoyaJapan
  6. 6.Division of Perioperative Medicine, Division of Surgical Oncology, Department of SurgeryNagoya University Graduate School of MedicineNagoyaJapan

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