Andrea J MacNeill1,2, Alessandro Gronchi2, Rosalba Miceli3, Sylvie Bonvalot4, Carol J Swallow1, Peter Hohenberger5, Frits Van Coevorden6, Piotr Rutkowski7, Dario Callegaro2, Andrew J Hayes8, Charles Honoré9, Mark Fairweather10, Amanda Cannell11, Jens Jakob5, Rick L Haas12, Milena Szacht7, Marco Fiore2, Paolo G Casali13, Raphael E Pollock14, Francesco Barretta3, Chandrajit P Raut10, Dirk C Strauss8. 1. Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Center, Department of Surgery, University of Toronto, Toronto, Canada. 2. Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 3. Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 4. Department of Surgery, Institute Curie, Paris, France. 5. University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany. 6. Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands. 7. Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland. 8. Department of Surgery, Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom. 9. Department of Surgery, Institute Gustave Roussy, Villejuif, France. 10. Department of Surgery, Division of Surgical Oncology, Brigham and Women's Hospital and Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA. 11. Ontario Institute for Cancer Research, MaRS Center, Toronto, Canada. 12. Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands. 13. Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 14. Department of Surgery, Division of Surgical Oncology, Ohio State University Medical Center, Columbus, OH.
Abstract
OBJECTIVE: To investigate the safety of radical resection for retroperitoneal sarcoma (RPS). BACKGROUND: The surgical management of RPS frequently involves complex multivisceral resection. Improved oncologic outcomes have been demonstrated with this approach compared to marginal excision, but the safety of radical resection has not been shown in a large study population. METHODS: The Transatlantic Retroperitoneal Sarcoma Working Group (TARPSWG) is an international collaborative of sarcoma centers. A combined experience of 1007 consecutive resections for primary RPS from January 2002 to December 2011 was studied retrospectively with respect to adverse events. A weighted organ score was devised to account for differences in surgical complexity. Univariate and multivariate logistic regression analyses were performed to investigate associations between adverse events and number and patterns of organs resected. Associations between adverse events and overall survival, local recurrence, and distant metastases were investigated. RESULTS: Severe postoperative adverse events (Clavien-Dindo ≥3) occurred in 165 patients (16.4%) and 18 patients (1.8%) died within 30 days. Significant predictors of severe adverse events were age (P = 0.003), transfusion requirements (P < 0.001), and resected organ score (P = 0.042). Resections involving pancreaticoduodenectomy, major vascular resection, and splenectomy/pancreatectomy were found to entail higher operative risk (odds ratio >1.5). There was no impact of postoperative adverse events on overall survival, local recurrence, or distant metastases. CONCLUSIONS: A radical surgical approach to RPS is safe when carried out at a specialist sarcoma center. High-risk resections should be carefully considered on an individual basis and weighed against anticipated disease biology. There appears to be no association between surgical morbidity and long-term oncologic outcomes.
OBJECTIVE: To investigate the safety of radical resection for retroperitoneal sarcoma (RPS). BACKGROUND: The surgical management of RPS frequently involves complex multivisceral resection. Improved oncologic outcomes have been demonstrated with this approach compared to marginal excision, but the safety of radical resection has not been shown in a large study population. METHODS: The Transatlantic Retroperitoneal Sarcoma Working Group (TARPSWG) is an international collaborative of sarcoma centers. A combined experience of 1007 consecutive resections for primary RPS from January 2002 to December 2011 was studied retrospectively with respect to adverse events. A weighted organ score was devised to account for differences in surgical complexity. Univariate and multivariate logistic regression analyses were performed to investigate associations between adverse events and number and patterns of organs resected. Associations between adverse events and overall survival, local recurrence, and distant metastases were investigated. RESULTS: Severe postoperative adverse events (Clavien-Dindo ≥3) occurred in 165 patients (16.4%) and 18 patients (1.8%) died within 30 days. Significant predictors of severe adverse events were age (P = 0.003), transfusion requirements (P < 0.001), and resected organ score (P = 0.042). Resections involving pancreaticoduodenectomy, major vascular resection, and splenectomy/pancreatectomy were found to entail higher operative risk (odds ratio >1.5). There was no impact of postoperative adverse events on overall survival, local recurrence, or distant metastases. CONCLUSIONS: A radical surgical approach to RPS is safe when carried out at a specialist sarcoma center. High-risk resections should be carefully considered on an individual basis and weighed against anticipated disease biology. There appears to be no association between surgical morbidity and long-term oncologic outcomes.
Authors: Naruhiko Ikoma; Christina L Roland; Keila E Torres; Yi-Ju Chiang; Wei-Lien Wang; Neeta Somaiah; Gary N Mann; Kelly K Hunt; Janice N Cormier; Barry W Feig Journal: J Surg Oncol Date: 2017-12-11 Impact factor: 3.454
Authors: Alex B Blair; Bradley N Reames; Jasvinder Singh; Faiz Gani; Heidi N Overton; Robert J Beaulieu; Ying W Lum; James H Black; Fabian M Johnston; Nita Ahuja Journal: J Surg Oncol Date: 2018-06-07 Impact factor: 3.454
Authors: Fabio Tirotta; Michael G Fadel; James Hodson; Alessandro Parente; Helene Wilkerson; L Max Almond; Samuel J Ford; Andrew J Hayes; Anant Desai; Dirk C Strauss Journal: Ann Surg Oncol Date: 2022-07-19 Impact factor: 4.339
Authors: Patrick B Schwartz; Christopher C Stahl; Cecilia Ethun; Nicholas Marka; George A Poultsides; Kevin K Roggin; Ryan C Fields; John H Howard; Callisia N Clarke; Konstantinos I Votanopoulos; Kenneth Cardona; Daniel E Abbott Journal: J Surg Oncol Date: 2020-06-17 Impact factor: 3.454
Authors: Christopher C Stahl; Patrick B Schwartz; Cecilia G Ethun; Nicholas Marka; Bradley A Krasnick; Thuy B Tran; George A Poultsides; Kevin K Roggin; Ryan C Fields; Callisia N Clarke; Konstantinos I Votanopoulos; Kenneth Cardona; Daniel E Abbott Journal: Ann Surg Oncol Date: 2020-11-04 Impact factor: 5.344