title: Results of Resection for Recurrent or Residual Retroperitoneal Sarcoma After Failed Primary Treatment.
abstract: BACKGROUND
  Local recurrence after resection of retroperitoneal sarcoma (RPS) is a common and difficult problem. Gross residual disease after incomplete resection is a particular challenge. The authors reviewed their experience with patients referred for management of recurrent or residual RPS.
  
  
  METHODS
  Patients seen at the authors' center from 1996 to 2013 who had undergone resection at an outside institution were identified from a prospective database. Kaplan-Meier survival curves were generated and compared by log-rank analysis.
  
  
  RESULTS
  A total of 45 patients were referred with recurrent (n = 33) or residual (n = 12) disease. Before initial surgery elsewhere, cross-sectional imaging (computed tomograpy/magnetic resonance imaging) had been obtained for 30 patients (67 %) and percutaneous biopsy for 8 patients (18 %). At referral to the authors' center, 15 patients were deemed inappropriate for resection, with a subsequent median overall survival (OS) period of 15 months. At the authors' center, 30 patients (22 with recurrent and 8 with residual disease) were resected. The majority received preoperative radiation (77 %). The postoperative mortality rate was 0 % in the recurrent group and 25 % (2/8) in the residual group (p = 0.015). Among the 30 resected patients, the median and 5-year OS was 53 months (50 %), and the OS was better in the recurrent group (median, 77 months) than in the residual group (median, 41 months (p = 0.027). The median time to local re-recurrence was 49 months in the recurrent group and 35 months in the residual group (p = 0.730).
  
  
  CONCLUSIONS
  Durable disease control and prolonged survival may be achieved for selected patients with recurrent RPS. In this study, resection after previous grossly incomplete resection was associated with high postoperative mortality and inferior OS. The benefit of extensive surgery for these patients may be limited.
authors.affiliation: Department of Surgery, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Trevor D
authors.initials: TD
authors.lastname: Hamilton
authors.affiliation: Ontario Institute for Cancer Research, Toronto, ON, Canada.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Cannell
authors.affiliation: Division of General Surgery, McMaster University, Hamilton, ON, Canada.
authors.forename: Minji
authors.initials: M
authors.lastname: Kim
authors.affiliation: Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada.
authors.forename: Charles N
authors.initials: CN
authors.lastname: Catton
authors.affiliation: Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
authors.forename: Martin E
authors.initials: ME
authors.lastname: Blackstein
authors.affiliation: Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada.
authors.forename: Brendan C
authors.initials: BC
authors.lastname: Dickson
authors.affiliation: Division of General Surgery, Mount Sinai Hospital, Toronto, ON, Canada.|Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada.|Department of Surgery, University of Toronto, Toronto, ON, Canada.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Gladdy
authors.affiliation: Division of General Surgery, Mount Sinai Hospital, Toronto, ON, Canada. CarolSwallow@sinaihealthsystem.com.|Department of Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada. CarolSwallow@sinaihealthsystem.com.|Department of Surgery, University of Toronto, Toronto, ON, Canada. CarolSwallow@sinaihealthsystem.com.
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Swallow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D018365:Neoplasm, Residual / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D011446:Prospective Studies; D012186:Retroperitoneal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D012509:Sarcoma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome