title: Postoperative Morbidity After Radical Resection of Primary Retroperitoneal Sarcoma: A Report From the Transatlantic RPS Working Group.
abstract: To investigate the safety of radical resection for retroperitoneal sarcoma (RPS).
  
  
  
  The surgical management of RPS frequently involves complex multivisceral resection. Improved oncologic outcomes have been demonstrated with this approach compared to marginal excision, but the safety of radical resection has not been shown in a large study population.
  
  
  
  The Transatlantic Retroperitoneal Sarcoma Working Group (TARPSWG) is an international collaborative of sarcoma centers. A combined experience of 1007 consecutive resections for primary RPS from January 2002 to December 2011 was studied retrospectively with respect to adverse events. A weighted organ score was devised to account for differences in surgical complexity. Univariate and multivariate logistic regression analyses were performed to investigate associations between adverse events and number and patterns of organs resected. Associations between adverse events and overall survival, local recurrence, and distant metastases were investigated.
  
  
  
  Severe postoperative adverse events (Clavien-Dindo ≥3) occurred in 165 patients (16.4%) and 18 patients (1.8%) died within 30 days. Significant predictors of severe adverse events were age (P = 0.003), transfusion requirements (P < 0.001), and resected organ score (P = 0.042). Resections involving pancreaticoduodenectomy, major vascular resection, and splenectomy/pancreatectomy were found to entail higher operative risk (odds ratio >1.5). There was no impact of postoperative adverse events on overall survival, local recurrence, or distant metastases.
  
  
  
  A radical surgical approach to RPS is safe when carried out at a specialist sarcoma center. High-risk resections should be carefully considered on an individual basis and weighed against anticipated disease biology. There appears to be no association between surgical morbidity and long-term oncologic outcomes.
authors.affiliation: Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Center, Department of Surgery, University of Toronto, Toronto, Canada.|Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Andrea J
authors.initials: AJ
authors.lastname: MacNeill
authors.affiliation: Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gronchi
authors.affiliation: Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Rosalba
authors.initials: R
authors.lastname: Miceli
authors.affiliation: Department of Surgery, Institute Curie, Paris, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Bonvalot
authors.affiliation: Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Center, Department of Surgery, University of Toronto, Toronto, Canada.
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Swallow
authors.affiliation: University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Hohenberger
authors.affiliation: Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Frits
authors.initials: F
authors.lastname: Van Coevorden
authors.affiliation: Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Rutkowski
authors.affiliation: Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Callegaro
authors.affiliation: Department of Surgery, Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Hayes
authors.affiliation: Department of Surgery, Institute Gustave Roussy, Villejuif, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Honoré
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Brigham and Women's Hospital and Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
authors.forename: Mark
authors.initials: M
authors.lastname: Fairweather
authors.affiliation: Ontario Institute for Cancer Research, MaRS Center, Toronto, Canada.
authors.forename: Amanda
authors.initials: A
authors.lastname: Cannell
authors.affiliation: University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Jakob
authors.affiliation: Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
authors.forename: Rick L
authors.initials: RL
authors.lastname: Haas
authors.affiliation: Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
authors.forename: Milena
authors.initials: M
authors.lastname: Szacht
authors.affiliation: Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Fiore
authors.affiliation: Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Paolo G
authors.initials: PG
authors.lastname: Casali
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Ohio State University Medical Center, Columbus, OH.
authors.forename: Raphael E
authors.initials: RE
authors.lastname: Pollock
authors.affiliation: Unit of Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Barretta
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Brigham and Women's Hospital and Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
authors.forename: Chandrajit P
authors.initials: CP
authors.lastname: Raut
authors.affiliation: Department of Surgery, Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Dirk C
authors.initials: DC
authors.lastname: Strauss
mesh_terms: D000368:Aged; D002170:Canada / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D016577:Pancreaticoduodenectomy; D011184:Postoperative Period; D012186:Retroperitoneal Neoplasms / Q000453:epidemiology / Q000601:surgery*; D012189:Retrospective Studies; D012509:Sarcoma / Q000453:epidemiology / Q000601:surgery*; D013156:Splenectomy; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology