Skip to main content

Advertisement

SpringerLink
Log in

Outcomes Following Extended Surgery for Retroperitoneal Sarcomas: Results From a UK Referral Centre

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Primary extended resection has been proposed as the initial treatment for patients with retroperitoneal sarcoma. This approach comprises an extended en-bloc resection of the directly infiltrated organs and adjacent uninvolved organs. The results of such radical surgery have yet to be validated. This retrospective study aims to investigate this practice in a contemporary series from a referral center in the UK.

Methods

We extracted data from consecutive patients who underwent extended resectional surgery between 2009 and 2013, and investigated the type of resection performed, the effectiveness of extended surgery in providing negative microscopic margins, and the occurrence of post-surgical adverse events.

Results

A total of 69 patients were included. Fifty-two patients had a primary tumor (75.4 %), and in 55 patients (79.7 %) the tumor was resected en bloc with adjacent organs or structures. Colonic resection (N = 35, 50.7 %) and nephrectomy (N = 28, 40.6 %) were the most frequently performed organ resections. Organs were infiltrated in 22 patients (32 %), and there was no association between organ infiltration and patient variables and staging characteristics. Negative microscopic margins were achieved in 88.6 % of patients in this series. Postoperative complications occurred in 21 patients (30 %) and a reoperation was required in ten cases (14.5 %). No independent predictors of morbidity were identified and no 30-day postoperative deaths occurred.

Conclusions

Four-fifths of patients in this series had organs removed in association with the retroperitoneal sarcoma. This approach in a specialist sarcoma unit results in negative microscopic tumor margins in up to 90 % of cases and can be performed safely.

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. Cormier JN, Pollock RE. Soft tissue sarcomas. CA Cancer J Clin. 2004;54:94–109.

    Article  PubMed  Google Scholar 

  2. Mastrangelo G, Coindre JM, Ducimetiere F, et al. Incidence of soft tissue sarcoma and beyond: a population-based prospective study in 3 European regions. Cancer. 2012;118:5339–48.

    Article  PubMed  Google Scholar 

  3. Miah AB, Hannay J, Benson C, et al. Optimal management of primary retroperitoneal sarcoma: an update. Expert Rev Anticancer Ther. 2014;14:565-579.

    Article  CAS  PubMed  Google Scholar 

  4. ESMO / European Sarcoma Network Working Group. Soft tissue and visceral sarcomas: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012;23 (Suppl 7):vii92–9.

  5. Grimer R, Judson I, Peake D, Seddon B. Guidelines for the management of soft tissue sarcomas. Sarcoma. 2010;2010:506182.

    PubMed Central  PubMed  Google Scholar 

  6. National Comprehensive Cancer Network. Clinical practice guidelines in oncology. Soft tissue sarcoma. Fort Washington: National Comprehensive Cancer Network; 2014.

    Google Scholar 

  7. Anaya DA, Lev DC, Pollock RE. The role of surgical margin status in retroperitoneal sarcoma. J Surg Oncol. 2008;98:607–10.

    Article  PubMed  Google Scholar 

  8. Lewis JJ, Leung D, Woodruff JM, Brennan MF. Retroperitoneal soft-tissue sarcoma: analysis of 500 patients treated and followed at a single institution. Ann Surg. 1998;228:355–65.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. 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;17:1507–14.

    Article  PubMed  Google Scholar 

  10. Gronchi A, Bonvalot S, Le Cesne A, Casali PG. Resection of uninvolved adjacent organs can be part of surgery for retroperitoneal soft tissue sarcoma. J Clin Oncol. 2009;27:2106–7; author reply 2107-2108.

    Article  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. Gronchi A, Miceli R, Colombo C, et al. Frontline extended surgery is associated with improved survival in retroperitoneal low- to intermediate-grade soft tissue sarcomas. Ann Oncol. 2012;23:1067–73.

    Article  CAS  PubMed  Google Scholar 

  13. Bonvalot S, Raut CP, Pollock RE, et al. Technical considerations in surgery for retroperitoneal sarcomas: position paper from E-Surge, a master class in sarcoma surgery, and EORTC-STBSG. Ann Surg Oncol. 2012;19:2981–91.

    Article  PubMed  Google Scholar 

  14. Strauss DC, Sandhu B, Hayes A, Thomas M. Surgical management of retroperitoneal leiomyosarcoma: tumour grade and site influence outcome. Connective Tissue Oncology Society 17th Annual Meeting; 14–17 Nov 2012; Prague.

  15. Fiore M, Colombo C, Locati P, et al. Surgical technique, morbidity, and outcome of primary retroperitoneal sarcoma involving inferior vena cava. Ann Surg Oncol. 2012;19:511–8.

    Article  PubMed  Google Scholar 

  16. 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.

    Article  PubMed  Google Scholar 

  17. Pollock RE. Extended surgery for retroperitoneal sarcoma: too much surgery for some and not enough for others? Oncology (Williston Park). 2013;27:641–2.

    PubMed  Google Scholar 

  18. Pisters PW. Resection of some—but not all—clinically uninvolved adjacent viscera as part of surgery for retroperitoneal soft tissue sarcomas. J Clin Oncol. 2009;27:6–8.

    Article  PubMed  Google Scholar 

  19. . Soft tissue and visceral sarcomas: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2014;25 (Suppl 3):iii102–12.

  20. Trans-Atlantic RPS Working Group. Management of primary retroperitoneal sarcoma (RPS) in the adult: a consensus approach from the Trans-Atlantic RPS Working Group. Ann Surg Oncol. 2015;22(1):256–63.

    Article  Google Scholar 

  21. Wilkinson MJ, Martin JL, Khan AA, Hayes AJ, Thomas JM, Strauss DC. Percutaneous core needle biopsy in retroperitoneal sarcomas does not influence local recurrence or overall survival. Ann Surg Oncol. 2014. doi:10.1245/s10434-014-4059-x.

    Google Scholar 

  22. Trojani M, Contesso G, Coindre JM, et al. Soft-tissue sarcomas of adults; study of pathological prognostic variables and definition of a histopathological grading system. Int J Cancer. 1984;33:37-42.

    Article  CAS  PubMed  Google Scholar 

  23. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien–Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.

    Article  PubMed  Google Scholar 

  24. Mussi C, Colombo P, Bertuzzi A, et al. Retroperitoneal sarcoma: is it time to change the surgical policy? Ann Surg Oncol. 2011;18:2136–42.

    Article  PubMed  Google Scholar 

  25. Gronchi A, Pollock R. Surgery in retroperitoneal soft tissue sarcoma: a call for a consensus between Europe and North America. Ann Surg Oncol. 2011;18:2107–10.

    Article  PubMed  Google Scholar 

  26. Gronchi A, Miceli R, Allard MA, et al. Personalizing the approach to retroperitoneal soft tissue sarcoma: histology-specific patterns of failure and postrelapse outcome after primary extended resection. Ann Surg Oncol. 2014. doi:10.1245/s10434-014-4130-7.

    Google Scholar 

  27. Bremjit PJ, Jones RL, Chai X, et al. A contemporary large single-institution evaluation of resected retroperitoneal sarcoma. Ann Surg Oncol. 2014;21:2150–8.

    Article  PubMed  Google Scholar 

  28. Tseng WW, Madewell JE, Wei W, et al. Locoregional disease patterns in well-differentiated and dedifferentiated retroperitoneal liposarcoma: implications for the extent of resection? Ann Surg Oncol. 2014;21:2136–43.

    Article  PubMed  Google Scholar 

  29. Ferrario T, Karakousis CP. Retroperitoneal sarcomas: grade and survival. Arch Surg. 2003;138:248–51.

    Article  PubMed  Google Scholar 

  30. Kilkenny JW 3rd, Bland KI, Copeland EM 3rd. Retroperitoneal sarcoma: the University of Florida experience. J Am Coll Surg. 1996;182:329–39.

    PubMed  Google Scholar 

  31. 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;92:359–68.

    Article  CAS  PubMed  Google Scholar 

  32. Singer S, Antonescu CR, Riedel E, Brennan MF. Histologic subtype and margin of resection predict pattern of recurrence and survival for retroperitoneal liposarcoma. Ann Surg. 2003;238:358–70; discussion 370-351.

    PubMed Central  PubMed  Google Scholar 

  33. Hassan I, Park SZ, Donohue JH, et al. Operative management of primary retroperitoneal sarcomas: a reappraisal of an institutional experience. Ann Surg. 2004;239:244–50.

    Article  PubMed Central  PubMed  Google Scholar 

  34. Gronchi A, Casali PG, Fiore M, et al. Retroperitoneal soft tissue sarcomas: patterns of recurrence in 167 patients treated at a single institution. Cancer. 2004;100:2448–55.

    Article  PubMed  Google Scholar 

  35. van Dalen T, Plooij JM, van Coevorden F, et al. Long-term prognosis of primary retroperitoneal soft tissue sarcoma. Eur J Surg Oncol. 2007;33:234–8.

    Article  PubMed  Google Scholar 

  36. Lehnert T, Cardona S, Hinz U, et al. Primary and locally recurrent retroperitoneal soft-tissue sarcoma: local control and survival. Eur J Surg Oncol. 2009;35:986–93.

    Article  CAS  PubMed  Google Scholar 

  37. Strauss DC, Hayes AJ, Thway K, Moskovic EC, Fisher C, Thomas JM. Surgical management of primary retroperitoneal sarcoma. Br J Surg. 2010;97:698–706.

    Article  CAS  PubMed  Google Scholar 

  38. Cho SY, Moon KC, Cheong MS, Kwak C, Kim HH, Ku JH. Significance of microscopic margin status in completely resected retroperitoneal sarcoma. J Urol. 2011;186:59–65.

    Article  PubMed  Google Scholar 

  39. Gronchi A, Miceli R, Shurell E, et al. 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. 2013;31:1649–55.

    Article  PubMed  Google Scholar 

  40. Anaya DA, Lahat G, Wang X, et al. Postoperative nomogram for survival of patients with retroperitoneal sarcoma treated with curative intent. Ann Oncol. 2010;21:397–402.

    Article  CAS  PubMed  Google Scholar 

  41. Rossi CR, Vecchiato A, Mastrangelo G, et al. Adherence to treatment guidelines for primary sarcomas affects patient survival: a side study of the European CONnective TIssue CAncer NETwork (CONTICANET). Ann Oncol. 2013;24:1685–91.

    Article  CAS  PubMed  Google Scholar 

  42. Ray-Coquard I, Thiesse P, Ranchere-Vince D, et al. Conformity to clinical practice guidelines, multidisciplinary management and outcome of treatment for soft tissue sarcomas. Ann Oncol. 2004;15:307–15.

    Article  CAS  PubMed  Google Scholar 

  43. Toulmonde M, Bonvalot S, Meeus P, et al. 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. 2014;25:735–42.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  44. Toulmonde M, Bonvalot S, Ray-Coquard I, et al. 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. 2014;25:730–4.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  45. Benson C, Judson I. Role of expert centres in the management of sarcomas: a UK perspective. Eur J Cancer. 2014;50:1951–6.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

The authors thank Miss Fiona Fitzgibbons, Clinical Nurse Specialist, for her help with the data collection.

Disclosure

The authors have no disclosures.

Author information

Authors and Affiliations

  1. Midlands Abdominal and Retroperitoneal Sarcoma Unit, The Queen Elizabeth Hospital Birmingham, Birmingham, UK

    Sandro Pasquali MD, Ravinder Vohra PhD, FRCS, Deepak Vijayan MRCS, David Gourevitch MD, FRCS & Anant Desai MD, FRCS

  2. Academic Department of Surgery, University of Birmingham, Birmingham, UK

    Ravinder Vohra PhD, FRCS

  3. Academic Department of Psychology, University of Birmingham, Birmingham, UK

    Ioanna Tsimopoulou MS

Authors
  1. Sandro Pasquali MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ravinder Vohra PhD, FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ioanna Tsimopoulou MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Deepak Vijayan MRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David Gourevitch MD, FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anant Desai MD, FRCS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anant Desai MD, FRCS.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 13 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pasquali, S., Vohra, R., Tsimopoulou, I. et al. Outcomes Following Extended Surgery for Retroperitoneal Sarcomas: Results From a UK Referral Centre. Ann Surg Oncol 22, 3550–3556 (2015). https://doi.org/10.1245/s10434-015-4380-z

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-015-4380-z

Keywords

Search

Navigation