Organ Infiltration and Patient Risk After Multivisceral Surgery for Primary Retroperitoneal Liposarcomas

Improta, Luca; Pasquali, Sandro; Iadecola, Sara; Barisella, Marta; Fiore, Marco; Radaelli, Stefano; Colombo, Chiara; Alloni, Rossana; Callegaro, Dario; Valeri, Sergio; Miceli, Rosalba; Gronchi, Alessandro

doi:10.1245/s10434-023-13314-9

Cited by 8 publications

(4 citation statements)

References 38 publications

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“…14 Despite advances in imaging modalities, the operating surgeon still combats the clinical challenge of resecting adjacent organs based on intraoperative concerns of invasion. 25,26 Several studies have investigated the involvement of adjacent organs as determined by histologic invasion and the implications on recurrence and survival. In a study by Fairweather et al 99 patients with resection of at least one additional organ for RPS were evaluated from 2002-2011.…”

Section: Discussionmentioning

confidence: 99%

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Comparing Multivisceral Resection with Tumor-only Resection of Liposarcoma Using the Win Ratio

Gorji,

Nikahd,

Onuma

et al. 2024

Ann Surg Oncol

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Background Multivisceral resection of retroperitoneal liposarcoma (LPS) is associated with increased morbidity and may not confer a survival benefit compared with tumor-only (TO) resection. We compared both approaches using a novel statistical method called the “win ratio” (WR). Methods Patients who underwent resection of LPS from 2004 to 2015 were identified from the National Cancer Database. Multivisceral resection was defined as removal of the primary site in addition to other organs. The WR was calculated based on a hierarchy of postoperative outcomes: 30-day and 90-day mortality, long-term survival, and severe complication. Results Among 958 patients (multivisceral 634, TO 324) who underwent resection, the median age was 63 years (interquartile range [IQR] 54–71) with a median follow-up of 51 months (IQR 30–86). There was no difference in the WR among patients who underwent TO versus multivisceral resection in the matched cohort (WR 0.82, 95% confidence interval [CI] 0.61–1.10). In patients aged 72–90 years, those who underwent multivisceral resection had 36% lower odds of winning compared with patients undergoing TO resection (WR 0.64, 95% CI 0.40–0.98). A subgroup analysis of patients classified as not having adjacent tumor involvement at the time of surgery revealed that those patients who underwent multivisceral resection had 33% lower odds of winning compared to TO resection (WR 0.67, 95% CI 0.45–0.99). Conclusions Based on win-ratio assessments of a hierarchical composite endpoint, multivisceral resection in patients without adjacent tumor involvement may not confer improved outcomes. This method supports the rationale for less invasive resection of LPS in select patients, especially older patients.

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Section: Discussionmentioning

confidence: 99%

“…25 In a retrospective study by Improta et was a prognostic indicator for OS and DFS, supporting the benefit of multivisceral resection. 26 Therefore, clinical suspicions of invasion are relevant points of consideration to account for during intraoperative resection.…”

Section: Discussionmentioning

confidence: 99%

Comparing Multivisceral Resection with Tumor-only Resection of Liposarcoma Using the Win Ratio

Gorji,

Nikahd,

Onuma

et al. 2024

Ann Surg Oncol

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“…In a most recent retrospective study of 109 patients who underwent frontline extended, multivisceral surgery for retroperitoneal liposarcoma [47], clinically relevant histological organ involvement was in 78% and 84% of patients with well-differentiated and dedifferentiated liposarcoma, respectively. Those high rates support the concept of frontline extended, multivisceral surgery in retroperitoneal liposarcoma.…”

Section: Frontline Extended Surgerymentioning

confidence: 99%

Retroperitoneal Soft Tissue Sarcoma: Emerging Therapeutic Strategies

de Bree,

Michelakis,

Heretis

et al. 2023

Cancers

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Retroperitoneal soft tissue sarcoma (RPS) is a rare and heterogenous disease for which surgery is the cornerstone of treatment. However, the local recurrence rate is much higher than in soft tissue sarcoma of the extremities since wide resection is usually unfeasible in RPS due to its large size, indistinct tumour borders, anatomical constraints and the thinness of the overlying peritoneum. Local recurrence is the leading cause of death for low-grade RPS, whereas high-grade tumours are prone to distant metastases. In recent decades, the role of emerging therapeutic strategies, such as more extended surgery and (neo)adjuvant treatments to improve oncological outcome in primary localised RPS, has been extensively investigated. In this review, the recent data on the evolving multidisciplinary management of primary localised RPS are comprehensively discussed. The heterogeneity of RPS, with their different histological subtypes and biological behaviour, renders a standard therapeutic ‘one-size-fits-all’ approach inappropriate, and treatment should be modified according to histological type and malignancy grade. There is sufficient evidence that frontline extended surgery with compartmental resection including all ipsilateral retroperitoneal fat and liberal en bloc resection of adjacent organs and structures, even if they are not macroscopically involved, increases local tumour control in low-grade sarcoma and liposarcoma, but not in leiomyosarcoma for which complete macroscopic resection seems sufficient. Additionally, preoperative radiotherapy is not indicated for all RPSs, but seems to be beneficial in well-differentiated liposarcoma and grade I/II dedifferentiated liposarcoma, and probably in solitary fibrous tumour. Whether neoadjuvant chemotherapy is of benefit in high-grade RPS remains unclear from retrospective data and is subject of the ongoing randomised STRASS 2 trial, from which the results are eagerly awaited. Personalised, histology-tailored multimodality treatment is promising and will likely further evolve as our understanding of the molecular and genetic characteristics within RPS improves.

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“…(de Bree et al 2023 ; von Mehren et al 2022 ). Radical excision is the cornerstone of therapy for improving survival among patients with RLPS (Improta et al 2023 ).…”

Section: Introductionmentioning

confidence: 99%

Surgical outcomes of major vascular resection for retroperitoneal liposarcoma from a high‑volume sarcoma center: a propensity score matching analysis

Xue,

Wang,

Liu

et al. 2024

J Cancer Res Clin Oncol

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Purpose Radical resection of retroperitoneal liposarcoma (RLPS) may necessitate vascular resection and reconstruction. The study was conducted to assess surgical outcomes of surgery for RLPS with major vascular involvement. Methods Patients with RLPS who underwent surgical resection at the Sarcoma Center of Peking University Cancer Hospital between April 2011 and December 2022 were identified from a prospectively maintained database. Patients were classified into two groups: vascular resection and non-vascular resection groups. A propensity score matching analysis was performed to eliminate baseline differences between the groups. Surgical details and postoperative outcomes were analyzed. Furthermore, prognostic factors for local recurrence-free survival (LRFS) and overall survival (OS) were assessed. Results Overall, 199 patients were identified and the median follow-up period was 48 (interquartile range [IQR] 45–69) months. Vascular resection was performed in 42 (21%) patients, 25 of whom had vascular infiltration. A total of 39 patients had vascular replacement and 3 patients underwent partial resection (side-wall resection). Vascular resection was burdened by higher rates of major morbidity (38% vs. 14%, p < 0.001) and 30-day mortality (7.1% vs. 1.3%, p = 0.005). After propensity-matched analysis, patients who underwent vascular resection had 5-year LRFS and OS rates comparable to those without vascular involvement. Major vascular resection was not an independent risk factor for LRFS or OS. Conclusions Although accompanied by increased risks of major morbidity and mortality, the major vascular resection enabled radical resection in patients with advanced RLPS, affording comparable 5-year LRFS and OS rates compared to those who did not.

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Organ Infiltration and Patient Risk After Multivisceral Surgery for Primary Retroperitoneal Liposarcomas

Cited by 8 publications

References 38 publications

Comparing Multivisceral Resection with Tumor-only Resection of Liposarcoma Using the Win Ratio

Comparing Multivisceral Resection with Tumor-only Resection of Liposarcoma Using the Win Ratio

Retroperitoneal Soft Tissue Sarcoma: Emerging Therapeutic Strategies

Surgical outcomes of major vascular resection for retroperitoneal liposarcoma from a high‑volume sarcoma center: a propensity score matching analysis

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