PURPOSE: To define the optimal initial management and the best extent of surgery that would optimize margins on primary retroperitoneal sarcomas (RPS). PATIENTS AND METHODS: A total of 382 patients with primary RPS were analyzed. Sixty-five patients had a simple resection of the tumor, 120 patients had a complete compartmental resection (systematic resection of noninvolved contiguous organs), 130 patients had a contiguously involved organ resection, 21 patients had a systematic re-excision, 38 patients had an incomplete gross resection, and eight patients had a biopsy alone. Radiotherapy and chemotherapy were administered to 121 and 145 patients, respectively. RESULTS: One, 3-, and 5-year overall survival (OS) rates were 86% (95% CI, 0.82 to 0.89), 66% (95% CI, 0.61 to 0.71), and 57% (95% CI, 0.51 to 0.62), respectively. Median overall survival was 6 years. In the multivariate analysis, high grade, tumor rupture, gross residual disease, and positive margins were associated with decreased OS. Low grade, no tumor rupture, negative histologic margins, a high number of patients undergoing operation per center, and compartmental resection compared with standard procedures were associated with decreased abdominal recurrences. Compartmental resection is a significant variable, predicting a 3.29-fold lower rate of abdominal recurrence compared with simple complete resection. CONCLUSION: Complete compartmental surgery without tumor rupture should be performed when possible to achieve clear margins. This surgery should be performed in a high-volume center. The role of adjuvant treatments should be evaluated in a randomized trial in association with this optimal surgery.
PURPOSE: To define the optimal initial management and the best extent of surgery that would optimize margins on primary retroperitoneal sarcomas (RPS). PATIENTS AND METHODS: A total of 382 patients with primary RPS were analyzed. Sixty-five patients had a simple resection of the tumor, 120 patients had a complete compartmental resection (systematic resection of noninvolved contiguous organs), 130 patients had a contiguously involved organ resection, 21 patients had a systematic re-excision, 38 patients had an incomplete gross resection, and eight patients had a biopsy alone. Radiotherapy and chemotherapy were administered to 121 and 145 patients, respectively. RESULTS: One, 3-, and 5-year overall survival (OS) rates were 86% (95% CI, 0.82 to 0.89), 66% (95% CI, 0.61 to 0.71), and 57% (95% CI, 0.51 to 0.62), respectively. Median overall survival was 6 years. In the multivariate analysis, high grade, tumor rupture, gross residual disease, and positive margins were associated with decreased OS. Low grade, no tumor rupture, negative histologic margins, a high number of patients undergoing operation per center, and compartmental resection compared with standard procedures were associated with decreased abdominal recurrences. Compartmental resection is a significant variable, predicting a 3.29-fold lower rate of abdominal recurrence compared with simple complete resection. CONCLUSION: Complete compartmental surgery without tumor rupture should be performed when possible to achieve clear margins. This surgery should be performed in a high-volume center. The role of adjuvant treatments should be evaluated in a randomized trial in association with this optimal surgery.
Authors: Sarah B Fisher; Yi-Ju Chiang; Barry W Feig; Janice N Cormier; Kelly K Hunt; Keila E Torres; Christina L Roland Journal: Am J Clin Oncol Date: 2019-02 Impact factor: 2.339
Authors: M Toulmonde; S Bonvalot; P Méeus; E Stoeckle; O Riou; N Isambert; E Bompas; M Jafari; C Delcambre-Lair; E Saada; A Le Cesne; C Le Péchoux; J Y Blay; S Piperno-Neumann; C Chevreau; J O Bay; V Brouste; P Terrier; D Ranchère-Vince; A Neuville; A Italiano Journal: Ann Oncol Date: 2014-03 Impact factor: 32.976
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Authors: Alexander L Lazarides; David L Kerr; Daniel P Nussbaum; R Timothy Kreulen; Jason A Somarelli; Dan G Blazer; Brian E Brigman; William C Eward Journal: Clin Orthop Relat Res Date: 2019-04 Impact factor: 4.176