title: Recurrent abdominal liposarcoma: analysis of 19 cases and prognostic factors.
abstract: OBJECTIVE
  To evaluate the clinical outcome of re-operation for recurrent abdominal liposarcoma following multidisciplinary team cooperation.
  
  
  METHODS
  Nineteen consecutive patients who had recurrent abdominal liposarcoma underwent re-operation by the retroperitoneal sarcoma team at our institution from May 2009 to January 2012. Patient demographic and clinical data were reviewed retrospectively. Multidisciplinary team discussions were held prior to treatment, and re-operation was deemed the best treatment. The categories of the extent of resection were as follows: gross total resection (GTR), palliative resection and partial resection. Surgical techniques were divided into discrete lesion resection and combined contiguous multivisceral resection (CMR). Tumor size was determined as the largest diameter of the specimen. Patients were followed up at approximately 3-monthly intervals. For survival analysis, a univariate analysis was performed using the Kaplan-Meier method, and a multivariate analysis was performed using the Cox proportional hazards model.
  
  
  RESULTS
  Nineteen patients with recurrent abdominal liposarcoma (RAL) underwent 32 re-operations at our institute. A total of 51 operations were reviewed with a total follow-up time ranging from 4 to 120 (47.4 ± 34.2) mo. The GTR rate in the CMR group was higher than that in the non-CMR group (P = 0.034). CMR was positively correlated with intra-operative bleeding (correlation coefficient = 0.514, P = 0.010). Six cases with severe postoperative complications were recorded. Patients with tumor sizes greater than 20 cm carried a significant risk of profuse intra-operative bleeding (P = 0.009). The ratio of a highly malignant subtype (dedifferentiated or pleomorphic) in recurrent cases was higher compared to primary cases (P = 0.027). Both single-factor survival using the Kaplan-Meier model and multivariate analysis using the Cox proportional hazards model showed that overall survival was correlated with resection extent and pathological subtype (P < 0.001 and P = 0.02), however, relapse-free interval (RFI) was only correlated with resection extent (P = 0.002).
  
  
  CONCLUSIONS
  Close follow-up should be conducted in patients with RAL. Early re-operation for relapse is preferred and gross resection most likely prolongs the RFI.
authors.affiliation: General Surgery Department, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Lu
authors.forename: James
authors.initials: J
authors.lastname: Lau
authors.forename: Mei-Dong
authors.initials: MD
authors.lastname: Xu
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhang
authors.forename: Ying
authors.initials: Y
authors.lastname: Jiang
authors.forename: Han-Xing
authors.initials: HX
authors.lastname: Tong
authors.forename: Juan
authors.initials: J
authors.lastname: Zhu
authors.forename: Wei-Qi
authors.initials: WQ
authors.lastname: Lu
authors.forename: Xin-Yu
authors.initials: XY
authors.lastname: Qin
mesh_terms: D000008:Abdominal Neoplasms / Q000401:mortality* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008080:Liposarcoma / Q000401:mortality* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000601:surgery*; D011379:Prognosis; D016016:Proportional Hazards Models; D012086:Reoperation; D012186:Retroperitoneal Neoplasms / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Overall survival; Recurrent abdominal liposarcoma; Relapse-free interval