Carolyn Nessim1, Chandrajit P Raut2, Dario Callegaro3, Francesco Barretta4, Rosalba Miceli4, Mark Fairweather2, Piotr Rutkowski5, Jean-Yves Blay6, Dirk Strauss7, Ricardo Gonzalez8, Nita Ahuja9, Giovanni Grignani10, Vittorio Quagliuolo11, Eberhard Stoeckle12, Antonino De Paoli13, Venu G Pillarisetty14, Carol J Swallow15, Sanjay P Bagaria16, Robert J Canter17, John T Mullen18, Yvonne Schrage19,20, Elisabetta Pennacchioli21, Winan van Houdt22, Kenneth Cardona23, Marco Fiore3, Alessandro Gronchi3, Guy Lahat24. 1. Department of Surgery, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada. cnessim@toh.ca. 2. Department of Surgery, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA. 3. Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 4. Unit of Clinical Epidemiology and Trial Organization, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 5. Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland. 6. Department of Medical Oncology, Center Léon Bérard Cancer Center, Lyon, France. 7. Department of Surgery, Royal Marsden Hospital NHS Foundation Trust, London, UK. 8. Department of Surgery, Moffitt Cancer Center, Tampa, FL, USA. 9. Department of Surgery, Yale School of Medicine, New Haven, CT, USA. 10. Division of Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy. 11. Department of Surgery, Istituto Clinico Humanitas IRCCS, Milan, Italy. 12. Department of Surgery, Institut Bergonié, Bordeaux, France. 13. Department of Radiation Oncology, Centro di Riferimento Oncologico, Aviano, Italy. 14. Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA. 15. Department of Surgery, Mount Sinai Hospital and Princess Margaret Cancer Center, Toronto, Canada. 16. Department of Surgery, Mayo Clinic, Jacksonville, FL, USA. 17. Department of Surgery, UC Davis Health, Sacramento, CA, USA. 18. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. 19. Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. 20. Department of Surgery, Netherlands Cancer Institute, Amsterdam, The Netherlands. 21. Division of Melanoma, Sarcomas and Rare Tumors, IEO, European Institute of Oncology, IRCCS, Milan, Italy. 22. Department of Surgery, Istituto Europeo di Oncologia, Milan, Italy. 23. Department of Surgery, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA. 24. Department of Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
Abstract
BACKGROUND: This study aimed to evaluate perioperative morbidity after surgery for first locally recurrent (LR1) retroperitoneal sarcoma (RPS). Data concerning the safety of resecting recurrent RPS are lacking. METHODS: Data were collected on all patients undergoing resection of RPS-LR1 at 22 Trans-Atlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG) centers from 2002 to 2011. Uni- and multivariable logistic models were fitted to study the association between major (Clavien-Dindo grade ≥ 3) complications and patient/surgery characteristics as well as outcome. The resected organ score, a method of standardizing the number of organs resected, as previously described by the TARPSWG, was used. RESULTS: The 681 patients in this study had a median age of 59 years, and 51.8% were female. The most common histologic subtype was de-differentiated liposarcoma (43%), the median resected organ score was 1, and 83.3% of the patients achieved an R0 or R1 resection. Major complications occurred for 16% of the patients, and the 90-day mortality rate was 0.4%. In the multivariable analysis, a transfusion requirement was found to be a significant predictor of major complications (p < 0.001) and worse overall survival (OS) (p = 0.010). However, having a major complication was not associated with a worse OS or a higher incidence of local recurrence or distant metastasis. CONCLUSIONS: A surgical approach to recurrent RPS is relatively safe and comparable with primary RPS in terms of complications and postoperative mortality when performed at specialized sarcoma centers. Because alternative effective therapies still are lacking, when indicated, resection of a recurrent RPS is a reasonable option. Every effort should be made to minimize the need for blood transfusions.
BACKGROUND: This study aimed to evaluate perioperative morbidity after surgery for first locally recurrent (LR1) retroperitoneal sarcoma (RPS). Data concerning the safety of resecting recurrent RPS are lacking. METHODS: Data were collected on all patients undergoing resection of RPS-LR1 at 22 Trans-Atlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG) centers from 2002 to 2011. Uni- and multivariable logistic models were fitted to study the association between major (Clavien-Dindo grade ≥ 3) complications and patient/surgery characteristics as well as outcome. The resected organ score, a method of standardizing the number of organs resected, as previously described by the TARPSWG, was used. RESULTS: The 681 patients in this study had a median age of 59 years, and 51.8% were female. The most common histologic subtype was de-differentiated liposarcoma (43%), the median resected organ score was 1, and 83.3% of the patients achieved an R0 or R1 resection. Major complications occurred for 16% of the patients, and the 90-day mortality rate was 0.4%. In the multivariable analysis, a transfusion requirement was found to be a significant predictor of major complications (p < 0.001) and worse overall survival (OS) (p = 0.010). However, having a major complication was not associated with a worse OS or a higher incidence of local recurrence or distant metastasis. CONCLUSIONS: A surgical approach to recurrent RPS is relatively safe and comparable with primary RPS in terms of complications and postoperative mortality when performed at specialized sarcoma centers. Because alternative effective therapies still are lacking, when indicated, resection of a recurrent RPS is a reasonable option. Every effort should be made to minimize the need for blood transfusions.
Authors: Sean J Judge; Kathleen Lata-Arias; Mio Yanagisawa; Morgan A Darrow; Arta M Monjazeb; Amanda R Kirane; Richard J Bold; Robert J Canter; Daniel J Canter Journal: J Surg Oncol Date: 2019-07-29 Impact factor: 3.454
Authors: Saul N Weingart; Jason Nelson; Benjamin Koethe; Omar Yaghi; Stephan Dunning; Albert Feldman; David Kent; Allison Lipitz-Snyderman Journal: Cancer Med Date: 2020-04-13 Impact factor: 4.452
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