Are Radical Compartmental Resections for Retroperitoneal Sarcomas Justified?

Raut, Chandrajit P.; Swallow, Carol J.

doi:10.1245/s10434-010-1061-9

Cited by 58 publications

(41 citation statements)

References 29 publications

(28 reference statements)

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“…5 It is also questionable whether a selective approach to resection of some 'disposable' organs (colon, kidney, psoas) adjacent to the tumour, while preserving other critical structures (inferior vena cava, aorta, superior mesenteric artery, liver) that also lie in contact with the tumour, could succeed in improving the overall survival. There is no reason to suggest that any one of the organs forming the borders of the retroperitoneum is more critical in determining local failure than any other.…”

Section: Surgical Managementmentioning

confidence: 99%

“…The inferior margin may relate to the iliopsoas muscle, the femoral nerve, the iliac vessels or pelvic sidewall. 5 Due to the inaccessibility of the region and since these tumours often give no or non-specific symptoms until they have reached a substantial size, they are usually large at presentation. 4 Sarcomas comprise a third of retroperitoneal tumours, with two histological subtypes predominating, namely liposarcoma (70%) and leiomyosarcoma (15%).…”

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confidence: 99%

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Retroperitoneal tumours: review of management

Strauß

Hayes

Thomas

2011

annals

131

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The retroperitoneum can host a wide spectrum of pathologies, including a variety of rare benign tumours and malignant neoplasms that can be either primary or metastatic lesions. Malignant tumours of the retroperitoneum occur four times more frequently than benign lesions.1 Sarcomas comprise a third of retroperitoneal tumours. Soft tissue sarcomas are rare tumours, with retroperitoneal sarcomas expected to compose approximately 15% of the 2,000 cases of soft tissue sarcomas anticipated in England and Wales each year.2 In the UK there are estimated to be between 250 and 300 new diagnoses of retroperitoneal sarcoma (RPS) each year. The retroperitoneum represents the second most common site of origin of malignant mesenchymal tumours after the lower extremities.3 Retroperitoneal tumours present several therapeutic challenges because of their relative late presentation and anatomical location (Fig 1). 4 This review highlights the presentation, evaluation and initial management of patients presenting with retroperitoneal tumours and the surgical management of RPS.A comprehensive literature search was conducted using PubMed. Relevant international articles published in the last ten years were assessed. The keywords for search purposes included: retroperitoneum, benign, sarcoma, neoplasm, diagnosis and surgery, radiotherapy, chemotherapy. The search was limited to articles published in English. All articles were read in full by the authors and selected for inclusion based on relevance to this article. BackgroundThe retroperitoneum represents a complex potential space with multiple vital structures bounded anteriorly by the peritoneum, ipsilateral colon and mesocolon, pancreas, liver or stomach. The posterior margins are by large composed of the psoas, quadratus lumborum, transverse abdominal and iliacus muscles but, depending on the tumour location and size, may be formed by the diaphragm, ipsilateral kidney, ureter and gonadal vessels. Similarly, the medial boundaries may include the spine, paraspinous muscles, the inferior vena cava (for right-sided tumours) and the aorta (for leftsided tumours). The lateral margin is formed by the lateral abdominal musculature and, depending on tumour location, may include the kidney and colon. Superiorly, retroperitoneal tumours may be in contact with the diaphragm, the right lobe The retroperitoneum can host a wide spectrum of pathologies, including a variety of rare benign tumours and malignant neoplasms that can be either primary or metastatic lesions. Retroperitoneal tumours can cause a diagnostic dilemma and present several therapeutic challenges because of their rarity, relative late presentation and anatomical location, often in close relationship with several vital structures in the retroperitoneal space. maTERiaLS and mEThodS a comprehensive literature search was conducted using Pubmed. Relevant international articles published in the last ten years were assessed. The keywords for search purposes included: retroperitoneum, benign, sarcoma, neoplasm, diagnosis and surgery, ra...

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Section: Surgical Managementmentioning

confidence: 99%

mentioning

confidence: 99%

Retroperitoneal tumours: review of management

Strauß

Hayes

Thomas

2011

annals

131

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“…However, histologically confirmed microscopic negative margins should remain the goal at resection, but may be challenging to achieve and difficult to evaluate. 3 The issue whether surgical quality and R0 status is operator-dependent or tumor biology-driven, and the relative contribution of these prognostic factors on outcome, will remain an ongoing debate. It is important to remember that margin status is the only potentially surgically-modifiable factor that can be optimized to offer the patient the best chance of cure.…”

Section: Complete Compartmental Resection Outcomesmentioning

confidence: 99%

“…1 There is an ongoing debate among specialist sarcoma surgeons regarding what constitutes optimal surgery for RPS; weighing up the possible oncological benefit of a radical multivisceral en bloc resection with possible increased early and late morbidity while keeping in mind the influence such radical surgery might or might not have on the inherent natural biology of the disease. 2,3 In this issue, Pollock et al 4 describe the patterns of recurrence following surgical resection of retroperitoneal liposarcoma, classifying patterns of recurrence according to tumor number and location in an attempt to correlate patterns of local failure to quality and extent of local therapy and tumor biology. This study expands on previous publications from the same unit on the prognostic value of multifocality in RPS.…”

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confidence: 99%

“…It must be kept in mind that these usually large tumors occurring in the retroperitoneal space can cause significant anatomical distortion and that the organs forming the threedimensional tumor margins can differ according to where the tumor develops. 3 The organs can also be completely displaced out of their normal anatomical location by tumor. The anterior margin is usually the ipsilateral colon and mesocolon, pancreas, duodenum, liver, or stomach.…”

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confidence: 99%

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Patterns of Recurrence in Retroperitoneal Liposarcomas: Reflecting Surgical Approach or Tumor Biology?

Strauß

2014

Ann Surg Oncol

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Complete surgical resection remains the mainstay of curative treatment for retroperitoneal sarcomas (RPS) and provides the only hope for long-term survival. Unfortunately, the major mode of failure leading to poor outcome for retroperitoneal liposarcoma is intra-abdominal locoregional recurrence. The cause for the high rate of local recurrence following resection of retroperitoneal liposarcomas in contrast to limb sarcoma is customarily attributed to the specific anatomical site, containing vital neural and vascular structures, axial skeleton, and visceral organs limiting the ability to perform a wide resection. In addition, inherent tumor biology of liposarcomas has to be considered. The biological behavior of retroperitoneal liposarcomas are unpredictable. Clinically, some well-differentiated (WD) RPS behave in an indolent fashion over many years and never develop a dedifferentiated (DD) component. Other DD RPS develop de novo without a documented WD component. Some WD RPS can recur with a mainly DD component and vice versa. Although WD and DD RPS have a common genetic feature associated with genomic amplification which include amplification in 12q13-15 resulting in MDM2 and CDK4 overexpression, the specific genetic and molecular events leading to the unpredictable behavior is still not clear.

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