Eran Nizri1,2, Marco Fiore1, Chiara Colombo1, Stefano Radaelli1, Dario Callegaro1, Roberta Sanfilippo3, Claudia Sangalli4, Paola Collini5, Carlo Morosi6, Silvia Stacchiotti3, Paolo G Casali3,7, Alessandro Gronchi1. 1. Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 2. Department of Surgery A, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel. 3. Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 4. Department of Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 5. Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 6. Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 7. Oncology and Haemato-Oncology Department, University of Milan, Milan, Italy.
Abstract
BACKGROUND: Patients with retroperitoneal sarcoma (RPSs) who undergo primary inadequate surgery before referral to specialized sarcoma centers may be considered for completion surgery (CS). We wanted to compare the outcome of these patients to those who underwent primary adequate surgery (PAS) at a single referral institution. METHODS: We identified 34 patients who were referred for CS after primary inadequate surgery. Using a propensity score based on validated RPS outcome risk factors, we managed to match 28 patients to patients with PAS. RESULTS: Median time lag between the first and second operation in CS patients was 5 months (2-15). Surgical extent was similar among groups (median number of organs resected = 3; P = 0.08), and macroscopically complete excision was achieved in all patients. The rate of severe complications did not differ between the groups (1 of 28 vs 3 of 28, respectively; P = 0.35) and no perioperative mortality was documented. Median follow-up was 43.5 months. Patients in the CS group had similar local recurrence-free survival (mean, 92.1 ± 9.7 vs 99.8 ± 12.4; P = 0.85) and relapse-free survival (mean, 88.7 ± 9.8 vs 80.9 ± 12.3; P = 0.3) to those with PAS. CONCLUSIONS: CS has short- and long-term outcomes comparable to PAS. While primary surgery should always be carried out at a referral institution, some of the patients who undergo an initial incomplete resection at a non specialist center can still be offered a salvage procedure at a referral institution with comparable results.
BACKGROUND:Patients with retroperitoneal sarcoma (RPSs) who undergo primary inadequate surgery before referral to specialized sarcoma centers may be considered for completion surgery (CS). We wanted to compare the outcome of these patients to those who underwent primary adequate surgery (PAS) at a single referral institution. METHODS: We identified 34 patients who were referred for CS after primary inadequate surgery. Using a propensity score based on validated RPS outcome risk factors, we managed to match 28 patients to patients with PAS. RESULTS: Median time lag between the first and second operation in CSpatients was 5 months (2-15). Surgical extent was similar among groups (median number of organs resected = 3; P = 0.08), and macroscopically complete excision was achieved in all patients. The rate of severe complications did not differ between the groups (1 of 28 vs 3 of 28, respectively; P = 0.35) and no perioperative mortality was documented. Median follow-up was 43.5 months. Patients in the CS group had similar local recurrence-free survival (mean, 92.1 ± 9.7 vs 99.8 ± 12.4; P = 0.85) and relapse-free survival (mean, 88.7 ± 9.8 vs 80.9 ± 12.3; P = 0.3) to those with PAS. CONCLUSIONS:CS has short- and long-term outcomes comparable to PAS. While primary surgery should always be carried out at a referral institution, some of the patients who undergo an initial incomplete resection at a non specialist center can still be offered a salvage procedure at a referral institution with comparable results.
Authors: William W Tseng; Carol J Swallow; Dirk C Strauss; Sylvie Bonvalot; Piotr Rutkowski; Samuel J Ford; Ricardo J Gonzalez; Rebecca A Gladdy; David E Gyorki; Mark Fairweather; Kyo Won Lee; Markus Albertsmeier; Winan J van Houdt; Magalie Fau; Carolyn Nessim; Giovanni Grignani; Kenneth Cardona; Vittorio Quagliuolo; Valerie Grignol; Jeffrey M Farma; Elisabetta Pennacchioli; Marco Fiore; Andrew Hayes; Dimitri Tzanis; Jacek Skoczylas; Max L Almond; John E Mullinax; Wendy Johnston; Hayden Snow; Rick L Haas; Dario Callegaro; Myles J Smith; Toufik Bouhadiba; Anant Desai; Rachel Voss; Roberta Sanfilippo; Robin L Jones; Elizabeth H Baldini; Andrew J Wagner; Charles N Catton; Silvia Stacchiotti; Khin Thway; Christina L Roland; Chandrajit P Raut; Alessandro Gronchi Journal: Ann Surg Oncol Date: 2022-06-29 Impact factor: 4.339
Authors: Carolyn Nessim; Chandrajit P Raut; Dario Callegaro; Francesco Barretta; Rosalba Miceli; Mark Fairweather; Piotr Rutkowski; Jean-Yves Blay; Dirk Strauss; Ricardo Gonzalez; Nita Ahuja; Giovanni Grignani; Vittorio Quagliuolo; Eberhard Stoeckle; Antonino De Paoli; Venu G Pillarisetty; Carol J Swallow; Sanjay P Bagaria; Robert J Canter; John T Mullen; Yvonne Schrage; Elisabetta Pennacchioli; Winan van Houdt; Kenneth Cardona; Marco Fiore; Alessandro Gronchi; Guy Lahat Journal: Ann Surg Oncol Date: 2021-01-02 Impact factor: 5.344