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Survival Benefit of the Surgical Management of Retroperitoneal Sarcoma in a Reference Center: A Nationwide Study of the French Sarcoma Group from the NetSarc Database



Guidelines recommend that retroperitoneal sarcoma (RPS) be managed in a reference sarcoma center (RSC), but the benefit remains to be demonstrated. This study investigated the impact of initial surgery performed within the NetSarc network on overall survival (OS).


NetSarc is a network of 26 RSCs with specialized multidisciplinary tumor boards (MDTs) that is funded by the French NCI. Since 2010, presentation to an MDT and second pathological review are mandatory for sarcoma patients, and data have been collected in a nationwide database. We extracted data for all patients who received surgery in or outside the network and who presented at a NetSarc center (NSC) for primary nonmetastatic RPS between 2010 and 2017.


A total of 2945 patients were included: 1078 (36.6%) underwent the first surgery in an NSC, and 1867 (63.4%) in an out-of-network center. The median number of operations at an NSC during the study period was 23 (range: 3–209), and the corresponding median was 1 (range: 1–2) at out-of-network centers. The diagnostic procedures followed significantly more clinical practice guidelines within NetSarc, where there were significantly more first R0 resections [452 (41.9%) vs. 230 (12.3%)]. The OS was significantly superior for patients treated within NetSarc, with a 2-year OS of 87% vs. 70% (p < 0.001). In the multivariate analysis, surgery within an NSC was an independent predictor of OS, with a twofold lower odds ratio of death.


In this national study, surgery for primary RPS within an NSC was associated with a better OS.

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  1. Mastrangelo G, Coindre JM, Ducimetière F, et al. Incidence of soft tissue sarcoma and beyond: a population-based prospective study in 3 European regions. Cancer. 2012;118(21):5339–48.

    Article  PubMed  Google Scholar 

  2. 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. 2015;22(5):1447–54.

    Article  PubMed  Google Scholar 

  3. 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  PubMed  Google Scholar 

  4. 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  PubMed  Google Scholar 

  5. 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  PubMed  Google Scholar 

  6. Fairweather M, Wang J, Jo VY, et al. Surgical management of primary retroperitoneal sarcomas: rationale for selective organ resection. Ann Surg Oncol. 2018;25(1):98–106.

    Article  PubMed  Google Scholar 

  7. Casali PG, Abecassis N, Aro HT, et al. Soft tissue and visceral sarcomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29(Suppl 4):iv268–9.

  8. von Mehren M, Randall RL, Benjamin RS, et al. Soft tissue sarcoma, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw. 2018;16(5):536–63.

  9. Surgery with or without radiation therapy in untreated nonmetastatic retroperitoneal sarcoma (STRASS). Accessed 06 May 2019.

  10. Nussbaum DP, Rushing CN, Lane WO, et al. Preoperative or postoperative radiotherapy versus surgery alone for retroperitoneal sarcoma: a case-control, propensity score-matched analysis of a nationwide clinical oncology database. Lancet Oncol. 2016;17(7):966–75.

    Article  PubMed  Google Scholar 

  11. Haas RLM, Bonvalot S, Miceli R, et al. Radiotherapy for retroperitoneal liposarcoma: a report from the Transatlantic Retroperitoneal Sarcoma Working Group. Cancer. 2019 Jan 2. [Epub ahead of print].

  12. Messiou C, Moskovic E, Vanel D, et al. Primary retroperitoneal soft tissue sarcoma: imaging appearances, pitfalls and diagnostic algorithm. Eur J Surg Oncol. 2017;43(7):1191–8.

    Article  CAS  PubMed  Google Scholar 

  13. MacNeill AJ, Miceli R, Strauss DC, et al. Post-relapse outcomes after primary extended resection of retroperitoneal sarcoma: a report from the Trans-Atlantic RPS Working Group. Cancer. 2017;123(11):1971–8.

    Article  CAS  PubMed  Google Scholar 

  14. Raut CP, Miceli R, Strauss DC, et al. External validation of a multi-institutional retroperitoneal sarcoma nomogram. Cancer. 2016;122(9):1417–24.

    Article  PubMed  Google Scholar 

  15. Trans-Atlantic RPS Working Group. Management of Recurrent Retroperitoneal Sarcoma (RPS) in the adult: a consensus approach from the Trans-Atlantic RPS Working Group. Ann Surg Oncol. 2016;23(11):3531–40.

    Article  PubMed Central  Google Scholar 

  16. 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 

  17. 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(9):2981–91.

    Article  PubMed  Google Scholar 

  18. 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 

  19. Trans-Atlantic Retroperitoneal Sarcoma Working Group (TARPSWG). Management of metastatic retroperitoneal sarcoma: a consensus approach from the Trans-Atlantic Retroperitoneal Sarcoma Working Group (TARPSWG). Ann Oncol. 2018;29(4):857–71.

  20. Gutierrez JC, Perez EA, Moffat FL, et al. Should soft tissue sarcomas be treated at high-volume centers? An analysis of 4205 patients. Ann Surg. 2007;245:952–8.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Maurice MJ, Yih JM, Ammori JB, Abouassaly R. Predictors of surgical quality for retroperitoneal sarcoma: volume matters. J Surg Oncol. 2017;116:766–74.

    Article  PubMed  Google Scholar 

  22. Keung EZ, Chiang YJ, Cormier JN, et al. Treatment at low-volume hospitals is associated with reduced short-term and long-term outcomes for patients with retroperitoneal sarcoma. Cancer. 2018;124(23):4495–503.

    Article  PubMed  Google Scholar 

  23. Berger NG, Silva JP, Mogal H, et al. Overall survival after resection of retroperitoneal sarcoma at academic cancer centers versus community cancer centers: an analysis of the National Cancer Data Base. Surgery. 2018;163(2):318–23.

    Article  PubMed  Google Scholar 

  24. Tumor of bone and soft tissues. R classification. In: Sobin LH, Wittekind CH, editors. TNM classification of malignant tumours. UICC 6th edn. New York: Wiley, 2002.

  25. 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 

  26. Derbel O, Heudel PE, Cropet C, et al. Survival impact of centralization and clinical guidelines for soft tissue sarcoma: a prospective and exhaustive population-based cohort. PLoS ONE. 2017;12(2):e0158406.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Raut CP, Bonvalot S, Gronchi A. A call to action: why sarcoma surgery needs to be centralized. Cancer. 2018;124(23):4452–4.

    Article  PubMed  Google Scholar 

  28. Andritsch E, Beishon M, Bielack Set al. ECCO essential requirements for quality cancer care: soft tissue sarcoma in adults and bone sarcoma. A critical review. Crit Rev Oncol Hematol. 2017;110:94–105.

    Article  PubMed  Google Scholar 

  29. Villano AM, Zeymo A, McDermott J, et al. Regionalization of retroperitoneal sarcoma surgery to high-volume hospitals: missed opportunities for outcome improvement. J Oncol Pract. 2018 Dec 14:JOP1800349. [Epub ahead of print]

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Supported by NetSarc (INCA & DGOS) and RREPS (INCA & DGOS), RESOS (INCA & DGOS) and LYRICAN (INCA-DGOS-INSERM 12563), Association DAM’s, Ensemble contre Le GIST, Eurosarc (FP7-278742), la Fondation ARC, Infosarcome, InterSARC (INCA), LabEx DEvweCAN (ANR-10-LABX-0061), Ligue de L’Ain contre le Cancer, La Ligue contre le Cancer, EURACAN (EC 739521).

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Correspondence to S. Bonvalot MD, PhD.

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Bonvalot, S., Gaignard, E., Stoeckle, E. et al. Survival Benefit of the Surgical Management of Retroperitoneal Sarcoma in a Reference Center: A Nationwide Study of the French Sarcoma Group from the NetSarc Database. Ann Surg Oncol 26, 2286–2293 (2019).

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