title: Preoperative radiation for retroperitoneal sarcoma is not associated with increased early postoperative morbidity.
abstract: OBJECTIVE
  Preoperative radiation (PR) in the management of retroperitoneal sarcoma (RPS) is controversial. Concern for increased perioperative morbidity may influence the decision to recommend PR. Here we compare 30-day morbidity and mortality (M + M) after resection of RPS with and without PR.
  
  
  METHODS
  Patients undergoing resection of RPS were identified using ACS NSQIP (2005-2011). Patients with known PR status within 90 days of operation were included. Univariate and multivariate logistic regression analyses were performed to identify factors associated with M + M.
  
  
  RESULTS
  Of 696 patients operated on for RPS, 70 (10%) underwent PR. PR patients were younger (mean 55 vs. 61 years), more frequently had hypoalbuminemia (<3 g/dl; 19% vs. 10%), concomitant kidney (29% vs. 18%), or pancreas resections (11% vs. 5%), longer operations (mean 327 vs. 253 min), and increased transfusion requirements (mean 4.1 vs. 2.1 units, each P < 0.05). Despite these differences, the M + M rate (31% with vs. 30% without PR, P = 0.75) was comparable between the two groups. After adjustment for confounders, no association was identified between PR and M + M.
  
  
  CONCLUSIONS
  In a national cohort of RPS patients, PR is infrequently utilized. Despite the increased prevalence of multiple risk factors, PR patients do not have an increased 30-day postoperative M + M.
authors.affiliation: Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Edmund K
authors.initials: EK
authors.lastname: Bartlett
authors.forename: Robert E
authors.initials: RE
authors.lastname: Roses
authors.forename: Chelsey
authors.initials: C
authors.lastname: Meise
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Fraker
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Kelz
authors.forename: Giorgos C
authors.initials: GC
authors.lastname: Karakousis
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015992:Body Mass Index; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009392:Nephrectomy; D061646:Operative Time; D050177:Overweight / Q000453:epidemiology; D010180:Pancreatectomy; D011183:Postoperative Complications / Q000453:epidemiology*; D018714:Radiotherapy, Adjuvant; D012186:Retroperitoneal Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D012509:Sarcoma / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D055815:Young Adult
keywords: morbidity and mortality; neoadjuvant radiation; retroperitoneal sarcoma