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Morbidity and Outcomes After Distal Pancreatectomy for Primary Retroperitoneal Sarcoma: An Analysis by the Trans-Atlantic Australasian Retroperitoneal Sarcoma Working Group

  • Sarcoma
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A Correction to this article was published on 17 March 2022

This article has been updated

Abstract

Background

Multi-visceral resection often is used in the treatment of retroperitoneal sarcoma (RPS). The morbidity after distal pancreatectomy for primary pancreatic cancer is well-documented, but the outcomes after distal pancreatectomy for primary RPS are not. This study aimed to evaluate morbidity and oncologic outcomes after distal pancreatectomy for primary RPS.

Methods

In this study, 26 sarcoma centers that are members of the Trans-Atlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG) retrospectively identified consecutive patients who underwent distal pancreatectomy for primary RPS from 2008 to 2017. The outcomes measured were 90-day severe complications (Clavien-Dindo ≥ 3), postoperative pancreatic fistula (POPF) rate, and oncologic outcomes.

Results

Between 2008 and 2017, 280 patients underwent distal pancreatectomy for primary RPS. The median tumor size was 25 cm, and the median number of organs resected, including the pancreas, was three. In 96% of the operations, R0/R1 resection was achieved. The 90-day severe complication rate was 40 %. The grades B and C POPF complication rates were respectively 19% and 5% and not associated with worse overall survival. Administration of preoperative radiation and factors to mitigate POPF did not have an impact on the risk for the development of a POPF. The RPS invaded the pancreas in 38% of the patients, and local recurrence was doubled for the patients who had a microscopic, positive pancreas margin (hazard ratio, 2.0; p = 0.042).

Conclusion

Distal pancreatectomy for primary RPS has acceptable morbidity and oncologic outcomes and is a reasonable approach to facilitate complete tumor resection.

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References

  1. Kleeff J, et al. Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases. Ann Surg. 2007;245:573–82.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Lillemoe KD, et al. Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg. 1999;229:693–8; discussion 698–700.

  3. Reeh M, et al. High surgical morbidity following distal pancreatectomy: still an unsolved problem. World J Surg. 2011;35:1110–7.

    Article  PubMed  Google Scholar 

  4. Ecker BL, et al. Risk factors and mitigation strategies for pancreatic fistula after distal pancreatectomy: analysis of 2026 resections from the International, Multi-institutional Distal Pancreatectomy Study Group. Ann Surg. 2019;269:143–9.

    Article  PubMed  Google Scholar 

  5. Gronchi A, 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;263:1002–9.

    Article  PubMed  Google Scholar 

  6. Tseng WW, Pollock RE, Gronchi A. The Trans-Atlantic Retroperitoneal Sarcoma Working Group (TARPSWG): “red wine or white”? Ann Surg Oncol. 2016;23:4418–20.

    Article  PubMed  Google Scholar 

  7. MacNeill AJ, et al. Postoperative morbidity after radical resection of primary retroperitoneal sarcoma: a report from the Transatlantic RPS Working Group. Ann Surg. 2018;267:959–64.

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  9. van Houdt WJ, et al. New research strategies in retroperitoneal sarcoma: the case of TARPSWG, STRASS, and RESAR: making progress through collaboration. Curr Opin Oncol. 2019;31:310–6.

    Article  PubMed  Google Scholar 

  10. Raut CP, et al. Predicting survival in patients undergoing resection for locally recurrent retroperitoneal sarcoma: a study and novel nomogram from TARPSWG. Clin Cancer Res. 2019;25:2664–71.

    Article  PubMed  Google Scholar 

  11. Haas RLM, et al. Radiotherapy for retroperitoneal liposarcoma: a report from the Transatlantic Retroperitoneal Sarcoma Working Group. Cancer. 2019;125:1290–300.

    Article  CAS  PubMed  Google Scholar 

  12. Bassi C, et al. (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. 2017;161:584–91.

    Article  PubMed  Google Scholar 

  13. Keung EZ, et al. Postoperative pancreatic fistula after distal pancreatectomy for non-pancreas retroperitoneal tumor resection. Am J Surg. 2020;220:140–6.

    Article  PubMed  Google Scholar 

  14. Miao Y, et al. Management of the pancreatic transection plane after left (distal) pancreatectomy: expert consensus guidelines by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2020.

  15. Fairweather M, et al. Incidence and adverse prognostic implications of histopathologic organ invasion in primary retroperitoneal sarcoma. J Am Coll Surg. 2017;224:876–83.

    Article  PubMed  Google Scholar 

  16. Toulmonde M, 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  CAS  PubMed  PubMed Central  Google Scholar 

  17. Berselli M, et al. Morbidity of left pancreatectomy when associated with multivisceral resection for abdominal mesenchymal neoplasms. JOP. 2011;12:138–44.

    PubMed  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Surgery, Mayo Clinic, Jacksonville, FL, USA

    Sanjay P. Bagaria MD, Emmanuel Gabriel MD, Matthew R. Spiegel BS & Zhou Li MS

  2. Department of Surgery, Mount Sinai Hospital and Princess Margaret Cancer Center, Toronto, Canada

    Carol Swallow MD & Harini Suraweera MS

  3. Division of Surgical Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Boston, MA, USA

    Chandrajit P. Raut MD & Mark Fairweather MD

  4. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy

    Ferdinando Cananzi MD & Vittorio Quagliuolo MD

  5. Sarcoma, Melanoma and Rare Tumors Surgery Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy

    Ferdinando Cananzi MD & Vittorio Quagliuolo MD

  6. Candiolo Cancer Institute, FPO-IRCCS, Str. Prov.le 142, Candiolo, Italy

    Giovanni Grignani MD

  7. Department of Surgical Oncology, University Hospitals Gasthuisberg, Leuven, Belgium

    Daphne Hompes MD

  8. Department of Surgery, University Hospitals Birmingham, Birmingham, UK

    Samuel J. Ford MD

  9. Department of Surgery, University of Ottawa, Ottawa, Canada

    Carolyn Nessim MD & Sameer Apte MD

  10. Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland

    Jacek Skoczylas MD & Piotr Rutkowski MD

  11. Department of Surgery, Institut Curie, Paris, France

    Sylvie Bonvalot MD & Dimitri Tzanis MD

  12. Division of Melanoma, Sarcomas and Rare Tumors, IEO, European Institute of Oncology, IRCCS, Milan, Italy

    Elisabetta Pennacchioli MD

  13. Department of General, Visceral, and Transplantation Surgery, Ludwig Maximilians Universitat Munich, Munich, Germany

    Markus Albertsmeier MD

  14. Department of Surgery, University of California-Davis School of Medicine, Sacramento, CA, USA

    Robert J. Canter MD

  15. Division of Surgical Oncology, The Ohio State University, Columbus, OH, USA

    Raphael Pollock MD & Valerie Grignol MD

  16. Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Kenneth Cardona MD & Adriana C. Gamboa MD

  17. Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia

    Marko Novak MD

  18. Department of Surgery, Institut Bergonie, Bordeaux, France

    Eberhard Stoeckle MD

  19. Department of Surgery, Skane University Hospital, Lund University, Lund, Sweden

    Martin Almquist MD

  20. Department of Surgery, Smilow Cancer Institute, Yale University School of Medicine, New Haven, CT, USA

    Nita Ahuja MD & Nicholas Klemen MD

  21. Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands

    Winan Van Houdt MD

  22. Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia

    Alexandra Gangi MD

  23. Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    David Gyorki MD

  24. Department of Surgical Oncology, Veneto Institute of Oncology, Padua, Italy

    Marco Rastrelli MD

  25. Department of Surgery, Leiden University Medical Center, Leiden, Netherlands

    Jos van der Hage MD & Yvonne Schrage MD

  26. Department of Surgery, Campus Bio-Medico, Rome, Italy

    Sergio Valeri MD

  27. Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Lorenzo Conti MD, Marco Fiore MD & Alessandro Gronchi MD

Authors
  1. Sanjay P. Bagaria MD
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  2. Carol Swallow MD
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  3. Harini Suraweera MS
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  4. Chandrajit P. Raut MD
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  5. Mark Fairweather MD
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  6. Ferdinando Cananzi MD
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  7. Vittorio Quagliuolo MD
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  8. Giovanni Grignani MD
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  9. Daphne Hompes MD
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  10. Samuel J. Ford MD
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  11. Carolyn Nessim MD
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  12. Sameer Apte MD
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  13. Jacek Skoczylas MD
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  14. Piotr Rutkowski MD
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  15. Sylvie Bonvalot MD
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  16. Dimitri Tzanis MD
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  17. Emmanuel Gabriel MD
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  18. Elisabetta Pennacchioli MD
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  19. Markus Albertsmeier MD
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  20. Robert J. Canter MD
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  21. Raphael Pollock MD
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  22. Valerie Grignol MD
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  23. Kenneth Cardona MD
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  24. Adriana C. Gamboa MD
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  25. Marko Novak MD
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  26. Eberhard Stoeckle MD
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  27. Martin Almquist MD
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  28. Nita Ahuja MD
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  29. Nicholas Klemen MD
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  30. Winan Van Houdt MD
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  31. David Gyorki MD
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  32. Alexandra Gangi MD
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  33. Marco Rastrelli MD
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  34. Jos van der Hage MD
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  35. Yvonne Schrage MD
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  36. Sergio Valeri MD
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  37. Lorenzo Conti MD
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  38. Matthew R. Spiegel BS
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  39. Zhou Li MS
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  40. Marco Fiore MD
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  41. Alessandro Gronchi MD
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Corresponding author

Correspondence to Sanjay P. Bagaria MD.

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Disclosure

Giovanni Grignani received grants from PharmaMar, Novartis, and Bayer and was a consultant for Novartis, Bayer, Pharmamar, EISAI, Lilly, and Merck. Piotr Rutkowski received honoraria from MSD, Bristol Myers Squibb, Novartis, Pierre Fabre, Amgen, Sanofi, Merck, Roche, and Blueprint Medicines. Sylvie Bonvalot received honoraria from Nanobiotix and Pharmamar. Nita Ahuja received funding from Astex on developing therapeutics for sarcomas.

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Presented at the Society of Surgical Oncology, 2020, and the International Conference on Surgical Cancer Care, August 2020, Boston, MA, USA.

The original online version of this article was revised: Elisabetta Pennacchioli's affiliation was corrected.

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Bagaria, S.P., Swallow, C., Suraweera, H. et al. Morbidity and Outcomes After Distal Pancreatectomy for Primary Retroperitoneal Sarcoma: An Analysis by the Trans-Atlantic Australasian Retroperitoneal Sarcoma Working Group. Ann Surg Oncol 28, 6882–6889 (2021). https://doi.org/10.1245/s10434-021-09739-9

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  • DOI: https://doi.org/10.1245/s10434-021-09739-9

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