Primary retroperitoneal sarcomas: a multivariate analysis of surgical factors associated with local control.
OBJECTIVE
To define the optimal initial management and the best extent of surgery that would optimize margins on primary retroperitoneal sarcomas (RPS).


METHODS
A total of 382 patients with primary RPS were analyzed. Sixty-five patients had a simple resection of the tumor, 120 patients had a complete compartmental resection (systematic resection of noninvolved contiguous organs), 130 patients had a contiguously involved organ resection, 21 patients had a systematic re-excision, 38 patients had an incomplete gross resection, and eight patients had a biopsy alone. Radiotherapy and chemotherapy were administered to 121 and 145 patients, respectively.


RESULTS
One, 3-, and 5-year overall survival (OS) rates were 86% (95% CI, 0.82 to 0.89), 66% (95% CI, 0.61 to 0.71), and 57% (95% CI, 0.51 to 0.62), respectively. Median overall survival was 6 years. In the multivariate analysis, high grade, tumor rupture, gross residual disease, and positive margins were associated with decreased OS. Low grade, no tumor rupture, negative histologic margins, a high number of patients undergoing operation per center, and compartmental resection compared with standard procedures were associated with decreased abdominal recurrences. Compartmental resection is a significant variable, predicting a 3.29-fold lower rate of abdominal recurrence compared with simple complete resection.


CONCLUSIONS
Complete compartmental surgery without tumor rupture should be performed when possible to achieve clear margins. This surgery should be performed in a high-volume center. The role of adjuvant treatments should be evaluated in a randomized trial in association with this optimal surgery.
Bonvalot
Sylvie
S
Department of Surgery, Public Health, and Medical Oncology, Institut Gustave-Roussy, Villejuif, France. bonvalot@igr.fr
Rivoire
Michel
M
Castaing
Marine
M
Stoeckle
Eberhard
E
Le Cesne
Axel
A
Blay
Jean Yves
JY
Laplanche
Agnès
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012186:Retroperitoneal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*