title: Is long-term survival possible after margin-positive resection of retroperitoneal sarcoma (RPS)?
abstract: OBJECTIVE
  For various reasons, some patients undergo a gross margin positive resection (R2) leading to a dilemma in care. We hypothesized that there is a subset of patients who have long-term survival (LTS, ≥5 years) after R2 resection for retroperitoneal sarcoma (RPS).
  
  
  METHODS
  National Cancer Database data from 1998 to 2011 were reviewed to identify patients with RPS who had R2 resections. Logistic and Cox regression models were used to compare LTS with short-term survival.
  
  
  RESULTS
  Of 12,028 patients, R2 resection rate was 3.28% (4.9% in 1998; 2.5% in 2011). Median survival for RPS with R2 resection was 21 months versus 69 months for those with R0/R1 resections (P < 0.001). Of 272 patients with available survival, 24% (n = 64) survived ≥5 years with 64% alive at follow-up. LTS was most often seen in younger patients (<65 years) with well-differentiated liposarcoma. Chemotherapy appeared to improve survival in the first 3 postoperative years, but paradoxical effects were seen in LTS (Hazards Ratio [HR] 0.69, 95%CI: 0.50-0.95, P = 0.024) in first 3 years versus (HR 2.15, 95%CI: 1.21-3.81, P = 0.009).
  
  
  CONCLUSIONS
  Long-term survival is possible for a subset of patients after an R2 resection for RPS, especially with favorable histology characteristics. Benefits of chemotherapy in margin positive settings need to be investigated. J. Surg. Oncol. 2016;113:823-827. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Brittany
authors.initials: B
authors.lastname: Klooster
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Rahul
authors.initials: R
authors.lastname: Rajeev
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Sarah
authors.initials: S
authors.lastname: Chrabaszcz
authors.affiliation: Section of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: John
authors.initials: J
authors.lastname: Charlson
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: John
authors.initials: J
authors.lastname: Miura
authors.affiliation: Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Meena
authors.initials: M
authors.lastname: Bedi
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Thomas Clark
authors.initials: TC
authors.lastname: Gamblin
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Fabian
authors.initials: F
authors.lastname: Johnston
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Kiran K
authors.initials: KK
authors.lastname: Turaga
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D011379:Prognosis; D012186:Retroperitoneal Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012509:Sarcoma / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents
keywords: clinicopathological factors; prognostic factor; resection margins; retroperitoneal sarcoma