title: Differences between en bloc resection and enucleation of retroperitoneal sarcomas.
abstract: OBJECTIVE
  Today, free margin surgery is the gold-standard management for soft-tissue sarcoma patients and one of the most important predictors of recurrence and survival. To obtain optimal results, a multidisciplinary approach is necessary. The aim of this study was to evaluate the evolution of patients with RPS treated by «en bloc«surgical resection versus those treated with enucleation in the first surgery.
  
  
  METHODS
  Fifty-six adult patients were divided into 2 groups. Patients in Group A underwent enucleation surgery, and patients in Group B underwent en bloc surgery. The endpoints of the study were survival time and time to recurrence, according to histological type and first surgical strategy.
  
  
  RESULTS
  Disease-free survival was longer for en bloc surgery (P<0,05), but there was no difference in overall survival. When comparing the histology of patients who underwent enucleation surgery and en bloc resection surgery, the disease-free survival and overall survival rates were longer for liposarcoma. In the multivariate analysis, only free margins and histology of liposarcoma were significantly associated with a better survival.
  
  
  CONCLUSIONS
  The surgical management of patients with retroperitoneal sarcoma must be very aggressive, often requiring multivisceral resection. Considering the disease-free survival and overall survival rates obtained, it is clear that it is critical to manage patients as early as possible by a radical en bloc surgery.
authors.affiliation: Servei Cirurgia General i Digestiva, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España; Servei Oncología Médica, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Servei Anatomia Patológica, Hospital de la Santa Creu i Sant Pau, Barcelona, España. Electronic address: jgonzalezl@santpau.cat.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Gonzalez Lopez
authors.affiliation: Servei Cirurgia General i Digestiva, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España.
authors.forename: Vicente
authors.initials: V
authors.lastname: Artigas Raventós
authors.affiliation: Servei Cirurgia General i Digestiva, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España.
authors.forename: Manuel
authors.initials: M
authors.lastname: Rodríguez Blanco
authors.affiliation: Servei Oncología Médica, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
authors.forename: Antonio
authors.initials: A
authors.lastname: Lopez-Pousa
authors.affiliation: Servei Anatomia Patológica, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bagué
authors.affiliation: Servei Cirurgia General i Digestiva, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España; Servei Oncología Médica, Hospital de la Santa Creu i Sant Pau, Barcelona, España; Servei Anatomia Patológica, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
authors.forename: Miriam
authors.initials: M
authors.lastname: Abellán
authors.affiliation: Servei Cirurgia General i Digestiva, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, España.
authors.forename: Manel
authors.initials: M
authors.lastname: Trias Folch
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012186:Retroperitoneal Neoplasms / Q000401:mortality / Q000601:surgery*; D012509:Sarcoma / Q000401:mortality / Q000601:surgery*; D013514:Surgical Procedures, Operative / Q000379:methods
keywords: Cirugía «en bloque»; En bloc resection; Multidisciplinary management; Retroperitoneal sarcoma; Sarcoma retroperitoneal; Tratamiento multidisciplinario