Abstract
Background
Retrorectal sarcomas are rare, and limited data are available on oncologic outcomes following surgery. Our aim was to evaluate outcomes in this patient population at our institution.
Materials and Methods
All patients who underwent surgical resection of a malignant retrorectal/presacral sarcoma between 1985 and 2005 were identified. Data analyzed included demographics, histopathologic diagnosis, surgical morbidity and mortality, use of adjuvant therapy, local and distant recurrence, and survival.
Results
A total of 37 patients were identified (20 males) with a median age of 49 years (range, 22–81 years). The most common histopathologic diagnosis was malignant peripheral nerve sheath tumor (n = 8). Also, 22 tumors were high grade and 15 were low grade. Surgical margin status was R0 in 31 patients and R1 in 6. Adjuvant therapy was given to 26 patients. Postoperative morbidity and mortality was 57% and 3%, respectively. Median length of follow-up in 16 patients alive at last contact was 4.7 years. The 5-year survival free of local (LDFS), distant (DDFS), and local or distant recurrence (DFS) was 51, 58, and 39%, respectively. Patient survival at 2, 5, and 10 years was 75, 55, and 47%, respectively. Disease-free survival was not significantly associated with gender (P = .16), primary vs secondary (P = .94), R0 vs R1 resection (P = .26), low vs high tumor grade (P = .17), or the use of surgery with or without adjuvant therapy (P = .33).
Conclusions
Retrorectal sarcomas are often high grade and locally advanced. Most tumors are resectable with free margins, and long-term survival may be possible in up to one-half of patients following an aggressive surgical approach.
Similar content being viewed by others
References
Cody HS 3rd, Marcove RC, Quan SH. Malignant retrorectal tumors: 28 years’ experience at Memorial Sloan-Kettering Cancer Center. Dis Colon Rectum. 1981;24:501–6.
Gray SW, Singhabhandhu B, Smith RA, Skandalakis JE. Sacrococcygeal chordoma: report of a case and review of the literature. Surgery. 1975;78:573–82.
Jao SW, Beart RW Jr, Spencer RJ, Reiman HM, Ilstrup DM. Retrorectal tumors: Mayo Clinic experience, 1960–1979. Dis Colon Rectum. 1985;28:644–52.
Fuchs B, Dickey ID, Yaszemski MJ, Inwards CY, Sim FH. Operative management of sacral chordoma. J Bone Joint Surg. 2005;87:2211–6.
Jackman RJ, Clark PL III, Smith ND. Retrorectal tumors. JAMA. 1951;145:956–62.
Whittaker LD, Pemberton JD. Tumors ventral to the sacrum. Ann Surg. 1938;107:96–106.
Wang JY, Hsu CH, Changchien CR, Chen JS, Hsu KC, You YT, et al. Presacral tumor: a review of forty-five cases. Am Surg. 1995;61:310–5.
Herr HW. Sarcomas of the urinary tract. In: de Kernion JB, Paulson DF, editors. Genitourinary Cancer Management. Philadelphia, PA: Lea & Febiger; 1987. p. 259–70.
Russo P, Brady MS, Conlon K, Hajdu SI, Fair WR, Herr HW, et al. Adult urological sarcoma. J Urol. 1992;47:1032–7.
Mackenzie S, Reid R, Barrett A, O’Dwyer PJ. Management of soft tissue sarcomas of the abdomen and pelvis. Colorectal Dis. 2003;5:129–32.
Keyzer-Dekker CM, Houtkamp RG, Peterse JL, van Coevorden F. Adult pelvic sarcomas: a heterogeneous collection of sarcomas. Sarcoma. 2004;8:19–24.
Lewis JJ, Leung D, Woodruff JM, Brennan MF. Retroperitoneal soft-tissue sarcoma. Analysis of 500 patients treated and followed at a singe institution. Ann Surg. 1998;228:355–65.
Karakousis CP, Kontzoglou K, Driscoll DL. Resectability of retroperitoneal sarcomas; a matter of surgical technique? Eur J Surg Oncol. 1995;21:617–22.
Zhang G, Chen KK, Manivel C, Fraley EE. Sarcomas of the retroperitoneum and genitourinary tract. J Urol. 1989;141:1107–10.
Raut CP, Pisters PW. Retroperitoneal sarcomas: combined-modality treatment approaches. J Surg Oncol. 2006;94:81–7.
Yang J, Chang A, Baker A, Sindelar WF, Danforth DN, Topalian SL, et al. Randomized prospective study of benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16:197–203.
Feng M, Murphy J, Griffith KA. Long-term outcomes after radiotherapy for retroperitoneal and deep truncal sarcoma. Int J Radiat Oncol Biol Phys. 2007;69:103–10.
Rosenberg S, Tepper J, Glatstein E, Costa J, Baker A, Brennan M, et al. The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluation of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant therapy. Ann Surg. 1982;196:305–15.
Tierney J, Stewart L, Parmar M, et al. Adjuvant chemotherapy for localized resectable soft-tissue sarcoma of adult: meta-analysis of individual data. Lancet. 1997;350:1647–54.
Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC Cancer Staging Manual. 7th ed. New York: Springer; 2010. p. 291.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Dozois, E.J., Jacofsky, D.J., Billings, B.J. et al. Surgical Approach and Oncologic Outcomes Following Multidisciplinary Management of Retrorectal Sarcomas. Ann Surg Oncol 18, 983–988 (2011). https://doi.org/10.1245/s10434-010-1445-x
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-010-1445-x