Andraz Perhavec1,2, Salvatore Provenzano3, Marco Baia4, Claudia Sangalli5, Carlo Morosi6, Marta Barisella7, Chiara Colombo4, Stefano Radaelli4, Sandro Pasquali4, Dario Callegaro4, Alessandro Gronchi4, Marco Fiore8. 1. Department of Surgery, Institute of Oncology Ljubljana, Ljubljana, Slovenia. 2. European School of Soft Tissue Sarcoma Surgery, Milan, Italy. 3. Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 4. Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 5. Department of Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 6. Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 7. Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 8. Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. marco.fiore@istitutotumori.mi.it.
Abstract
BACKGROUND: The outcome of patients with retroperitoneal sarcomas (RPS) depends mainly on tumor biology and completeness of surgical resection. However, some patients are deemed not resectable for various reasons. This study analyzed a series of primary RPS patients to describe rate and reasons of primary inoperability at a large referral center. METHODS: All consecutive patients affected by primary localized RPS referred for surgical treatment at our institution between January 1, 2013 and December 31, 2017 were analyzed. Patients were split in two groups: those who underwent surgical resection with curative intent, and those who were not resected. RESULTS: A total of 322 patients were available for the current analysis: 285 (88.5%) underwent resection with curative intent, and 37 (11.5%) did not. Twenty of 322 (6.2%) patients who did not undergo resection had a technically unresectable tumor, whereas the remaining 18 of 322 (5.6%) were not amenable to a major surgical procedure due to comorbidities/poor performance status. The dominant technical reason was involvement of the celiaco-mesenteric vessels. At a median follow-up from the diagnosis of 34 months, 24 of 37 (64.9%) nonoperated and 48 of 285 (16.8%) operated patients died. The corresponding 4-year overall survival were 10.3% and 83.4%, respectively (p < 0.001). CONCLUSIONS: Roughly, 10% of patients who presented with localized primary RPS at a large referral institution were not resected. An attempt to standardize the definition of resectability for primary localized RPS should be made considering anatomic, biologic, and patient-related factors.
BACKGROUND: The outcome of patients with retroperitoneal sarcomas (RPS) depends mainly on tumor biology and completeness of surgical resection. However, some patients are deemed not resectable for various reasons. This study analyzed a series of primary RPS patients to describe rate and reasons of primary inoperability at a large referral center. METHODS: All consecutive patients affected by primary localized RPS referred for surgical treatment at our institution between January 1, 2013 and December 31, 2017 were analyzed. Patients were split in two groups: those who underwent surgical resection with curative intent, and those who were not resected. RESULTS: A total of 322 patients were available for the current analysis: 285 (88.5%) underwent resection with curative intent, and 37 (11.5%) did not. Twenty of 322 (6.2%) patients who did not undergo resection had a technically unresectable tumor, whereas the remaining 18 of 322 (5.6%) were not amenable to a major surgical procedure due to comorbidities/poor performance status. The dominant technical reason was involvement of the celiaco-mesenteric vessels. At a median follow-up from the diagnosis of 34 months, 24 of 37 (64.9%) nonoperated and 48 of 285 (16.8%) operated patientsdied. The corresponding 4-year overall survival were 10.3% and 83.4%, respectively (p < 0.001). CONCLUSIONS: Roughly, 10% of patients who presented with localized primary RPS at a large referral institution were not resected. An attempt to standardize the definition of resectability for primary localized RPS should be made considering anatomic, biologic, and patient-related factors.
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Authors: Carol J Swallow; Dirk C Strauss; Sylvie Bonvalot; Piotr Rutkowski; Anant Desai; Rebecca A Gladdy; Ricardo Gonzalez; David E Gyorki; Mark Fairweather; Winan J van Houdt; Eberhard Stoeckle; Jae Berm Park; Markus Albertsmeier; Carolyn Nessim; Kenneth Cardona; Marco Fiore; Andrew Hayes; Dimitri Tzanis; Jacek Skoczylas; Samuel J Ford; Deanna Ng; John E Mullinax; Hayden Snow; Rick L Haas; Dario Callegaro; Myles J Smith; Toufik Bouhadiba; Silvia Stacchiotti; Robin L Jones; Thomas DeLaney; Christina L Roland; Chandrajit P Raut; Alessandro Gronchi Journal: Ann Surg Oncol Date: 2021-04-14 Impact factor: 4.339