Morbidity and Mortality after Surgery for Retroperitoneal Sarcoma

Abstract

Retroperitoneal sarcoma (RPS) is a rare disease with over 100 histologic types and accounts for 10–15% of all soft tissue sarcomas. Due to the rarity of RPS, sarcoma centers in Europe and North America have created the Transatlantic RPS Working Group (TARPSWG) to study this disease and establish best practices for its management. Current guidelines dictate complete resection of all macro and microscopic disease as the gold standard for patients with RPS. Complete extirpation often requires a multi-visceral resection. In addition, recent evidence suggests that en bloc compartmental resections are associated with reduced rates of local recurrence. However, this approach must be balanced by the potential for added morbidity. Strategies to mitigate postoperative complications include optimization of the patient through improved preoperative nutrition and pre-habilitation therapy, referral to a high-volume sarcoma center, and implementation of enhanced recovery protocols. This review will focus on the factors associated with perioperative complications following surgery for RPS and outline approaches to mitigate poor surgical outcomes in this patient population.

The Role of Surgery in Oligometastatic Retroperitoneal Sarcoma

“…For the evaluation of patient candidacy for surgery in general, common perioperative evaluation includes baseline functional status, comorbidities, and nutritional status. Multiple studies have demonstrated a correlation between adequate perioperative nutrition and decreased complications [ 66 , 67 ]. Multiple indices exist that can be utilized in patient selection, including frailty and fragility indices, NISQIP, ASA, and Cardiac Risk calculators [ 68 , 69 , 70 , 71 , 72 ].…”