Operative management of primary retroperitoneal sarcomas: a reappraisal of an institutional experience

Abstract

Objective: To review our recent experience with primary retroperitoneal sarcomas, determine prognostic factors for disease recurrence and patient survival, and compare them to our previous results.

Background: Medical therapies have shown little efficacy in the management of retroperitoneal sarcomas, making total surgical extirpation the best chance for patient cure.

Methods: The case histories of all patients operated upon for retroperitoneal sarcomas between January 1983 and December 1995 were retrospectively reviewed.

Results: Ninety-seven patients underwent attempted surgical resection of a primary retroperitoneal sarcoma. There were 54 (56%) men and 43 (44%) women, with a mean age of 59 years. Seventy-six (78%) patients underwent gross total resection, 13 (14%) had residual disease, and 8 (8%) underwent biopsy only with an actuarial 1-year survival of 88%, 51%, and 47%, respectively (P = 0.001). The actuarial 5- and 10-year survivals for patients who underwent gross total resection were 51% and 36%, respectively. Thirty-three patients (43%) developed locoregional recurrence, and 20 patients (26%) developed distant metastases at a median time of 12 months. The cumulative probability at 5 years was 44% for locoregional recurrence and 29% for distant metastases. On univariate analysis, factors associated with improved survival were complete resection of the tumor (P = 0.001), nonmetastatic disease at presentation (P = 0.01), low-grade tumors (P = 0.02), liposarcomas (P = 0.003), and no disease recurrence (P = 0.0001). Contrary to previous reports, the histologic subtype (P = 0.04) was the only significant factor predicting survival on multivariate analysis.

Conclusions: Compared with our earlier experience, the rates of complete resection and overall survival have improved. Local control continues to be a significant problem in the management of retroperitoneal sarcomas. Because new surgical options for this problem are limited, further outcome improvement requires novel adjuvant therapies.

FIGURE 1. Survival curves of patients by type of operation. Patients undergoing complete resection (n = 76) had a better survival as compared with patients with incomplete resection (n = 13) or biopsy (n = 8); P = 0.001.

FIGURE 2. Survival curves of patients by histologic subtype. Patients with leiomyosarcomas (n = 22) had a worse survival as compared with patients with liposarcomas (n = 44); P = 0.0001.

FIGURE 3. Survival curves of patients who developed recurrence after complete resection. Patients who underwent complete resection (n=15) of their recurrence had a better survival as compared with those who residual disease or biopsy only (n=9) or no resection at all (n=19), P = 0.001).

FIGURE 4. Survival curves of patients who underwent attempted resection of primary retroperitoneal sarcomas between 1960–1982 (n = 95 patients) and 1983–1995 (n = 97 patients) at the Mayo Clinic.