Advertisement

Retroperitoneal Sarcomas: Prognostic Factors and Outcomes of a Series of Patients Treated at a Single Institution

  • Shraddha Patkar
  • Abhay K Kattepur
  • Rajesh Shinde
  • Mahesh GoelEmail author
Original Article
  • 2 Downloads

Abstract

Retroperitoneal sarcomas (RPS) are rare heterogeneous tumors arising in the retroperitoneum with unique biological and behavioral patterns that are thought to be closely linked to histology. The aim of the study was to audit our results and analyze various clinico-pathological factors including surgical excision, histology, and their implications on the recurrences and survival outcomes in RPS. Retrospective analysis of patients treated at a tertiary referral center in India from March 2008 to July 2017 was performed. The clinico-pathological variables were analyzed for their association with tumor recurrence and survival with special emphasis on histological subtype. The primary outcome was overall survival (OS). One hundred consecutive patients operated for RPS were analyzed. Of these, 27 were operated for recurrent tumors. Liposarcomas (LPS) and leiomyosarcomas (LMS) constituted 50% (n = 50) and 30% (n = 30) of patients respectively. Complete tumor excision was achieved in 83%, with 43% patients undergoing adjacent organ resection. At a median follow-up of 25.3 months, the median disease-free survival (DFS) and overall survival (OS) were 30 months and 87.8 months respectively. On multivariate analysis, tumor grade was the only factor to significantly affect survival (p = 0.001 for DFS and 0.005 for OS). There was no difference in survival outcomes between infiltrative and adhesive tumors with respect to adjacent organ invasion (p = 0.361 for OS). Tumor grade remains an important prognostic factor affecting disease-free and overall survival in retroperitoneal sarcomas irrespective of tumor size, site, and histology.

Keywords

Retroperitoneal sarcoma Multivisceral resection Grade Histology 

Notes

Acknowledgments

We would sincerely thank Dr. A. Gronchi, Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy, for providing valuable inputs during the manuscript drafting and editing.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

Informed consent was obtained from the patients for surgery.

References

  1. 1.
    Panda N, Das R, Banerjee S, Chatterjee S, Gumta M, Bandyopadhyay SK (2015) Retroperitoneal sarcoma: outcome analysis in a teaching hospital in Eastern India- a perspective. Indian J Surg Oncol 6(2):99–105CrossRefGoogle Scholar
  2. 2.
    Tan MCB, Brennan MF, Kuk D, Agaram NP, Antonescu CR, Qin LX, Moraco N, Crago AM, Singer S (2016) Histology-based classification predicts pattern of recurrence and improves risk stratification in primary retroperitoneal sarcoma. Ann Surg 263(3):593–600CrossRefGoogle Scholar
  3. 3.
    Francis IR, Cohan RH, Varma DGK, Sondak VK (2005) Retroperitoneal sarcomas. Cancer Imaging 5:89–94CrossRefGoogle Scholar
  4. 4.
    MacNeill AJ, Fiore M (2017) Surgical morbidity in retroperitoneal sarcoma resection. J Surg Oncol. Jan 117(1):56–61.  https://doi.org/10.1002/jso.24902 CrossRefGoogle Scholar
  5. 5.
    Matthyssens LE, Creytens D, Ceelen WP (2015) Retroperitoneal liposarcoma: current insights in diagnosis and treatment. Front Surg 2:4CrossRefGoogle Scholar
  6. 6.
    Coindre JM (2006) Grading of soft tissue sarcomas: review and update. Arch Pathol Lab Med 130:1448–1453PubMedGoogle Scholar
  7. 7.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefGoogle Scholar
  8. 8.
    MacNeill AJ, Gronchi A, Miceli R, Bonvalot S, Swallow CJ, Hohenberger P, van Coevorden F, Rutkowski P, Callegaro D, Hayes AJ, Honoré C, Fairweather M, Cannell A, Jakob J, Haas RL, Szacht M, Fiore M, Casali PG, Pollock RE, Barretta F, Raut CP, Strauss DC (2018) Postoperative morbidity after radical resection of primary retroperitoneal sarcoma: a report from the Transatlantic RPS Working Group. Ann Surg 267(5):959–964CrossRefGoogle Scholar
  9. 9.
    Hogg HDJ, Manas DM, Lee D, Dildey P, Scott J, Lunec J, French JJ (2016) Surgical outcome and patterns of recurrence for retroperitoneal sarcoma at a single centre. Ann R Coll Surg Engl 98:192–197CrossRefGoogle Scholar
  10. 10.
    Wan Jie NG, Tan GHC, Chia CS et al (2017) Tumor biology remains the main determinant of prognosis in retroperitoneal sarcomas: a 14-year single-center experience. Asia-Pac J Clin Oncol 13:e458–e465CrossRefGoogle Scholar
  11. 11.
    Fairweather M, Wang J, Jo VY, Baldini EH, Bertagnolli MM, Raut CP (2017) Incidence and adverse prognostic implications of histopathologic organ invasion in primary retroperitoneal sarcoma. J Am Coll Surg 224:876–883CrossRefGoogle Scholar
  12. 12.
    Gronchi A, Miceli R, Shurell E, Eilber FC, Eilber FR, Anaya DA, Kattan MW, Honoré C, Lev DC, Colombo C, Bonvalot S, Mariani L, Pollock RE (2013) Outcome prediction in primary resected retroperitoneal soft tissue sarcoma: histology-specific overall survival and disease-free survival nomograms built on major sarcoma center data sets. J Clin Oncol 31:1649–1655CrossRefGoogle Scholar
  13. 13.
    Kim DB, Gray R, Li Z, Wasif N, Bagaria SP. (2018) Effect of nephrectomy for retroperitoneal sarcoma on post-operative renal function. J Surg Oncol. 117(3):425–429.  https://doi.org/10.1002/jso.24875 CrossRefGoogle Scholar
  14. 14.
    Sandrucci S, Ponzetti A, Gianotti C et al (2018) Different quality of treatment in retroperitoneal sarcomas (RPS) according to hospital-case volume and surgeon-case volume: a retrospective regional analysis in Italy. Clin Sarcoma Res 8:3CrossRefGoogle Scholar
  15. 15.
    Abdelfatah E, Guzzetta AA, Nagarajan N, Wolfgang CL, Pawlik TM, Choti MA, Schulick R, Montgomery EA, Meyer C, Thornton K, Herman J, Terezakis S, Frassica D, Ahuja N (2016) Long-term outcomes in treatment of retroperitoneal sarcomas: a 15 year single-institution evaluation of prognostic features. J Surg Oncol 114(1):56–64CrossRefGoogle Scholar
  16. 16.
    Wang Z, Wu J, Lv A, Li CP, Tian XY, Hao CY (2018) Anterior approach to en bloc resection in left-sided retroperitoneal sarcoma with adjacent organ involvement: a study of 25 patients in a single center. Med Sci Monit 24:961–969CrossRefGoogle Scholar
  17. 17.
    Stahl JM, Corso CD, Park HS, An Y, Rutter CE, Han D, Roberts KB (2017) The effect of microscopic margin status on survival in adult retroperitoneal soft tissue sarcomas. Eur J Surg Oncol 43:168–174CrossRefGoogle Scholar
  18. 18.
    Klooster B, Rajeev R, Chrabaszcz S et al (2016) Is long-term survival possible after margin-positive resection of retroperitoneal sarcoma (RPS)? J Surg Oncol 113:823–827CrossRefGoogle Scholar
  19. 19.
    Guiliano K, Nagarajan N, Canner JK et al (2016) Predictors of improved survival for patients with retroperitoneal sarcoma. Surgery 160:1628–1635CrossRefGoogle Scholar
  20. 20.
    Berger NG, Silva JP, Mogal H et al (2018) Overall survival after resection of retroperitoneal sarcoma at academic cancer centers versus community cancer centers: an analysis of the National Cancer Data Base. Surgery 163:318–323CrossRefGoogle Scholar
  21. 21.
    Rosa F, Fiorillo C, Tortorelli AP et al (2016) Surgical management of retroperitoneal soft tissue sarcomas: role of curative resection. Am Surg 82(2):128–133PubMedGoogle Scholar
  22. 22.
    Amersi F, Forscher C, Silberman AW Surgical resection of retroperitoneal sarcomas: analysis of factors determining outcome:105–113.  https://doi.org/10.1615/CritRevOncog.2016016967 CrossRefGoogle Scholar
  23. 23.
    Maurice MJ, Yih JM, Ammori JB, Abouassaly R (2017) Predictors of surgical quality for retroperitoneal sarcoma: volume matters. J Surg Oncol 116:766–774CrossRefGoogle Scholar

Copyright information

© Indian Association of Surgical Oncology 2020

Authors and Affiliations

  • Shraddha Patkar
    • 1
  • Abhay K Kattepur
    • 1
  • Rajesh Shinde
    • 1
  • Mahesh Goel
    • 1
    Email author
  1. 1.Department of Gastrointestinal Surgical OncologyTata Memorial Centre, Homi Bhabha National InstituteMumbaiIndia

Personalised recommendations