The importance of surgical margins in retroperitoneal sarcoma

Abstract

Surgery is the "gold-standard" treatment for retroperitoneal sarcomas, but local recurrence is common, and can cause disease-related death. Complete gross resection is associated with improved survival, but debate exists as to whether resection of adjacent organs to improve margins or prescription of neoadjuvant radiation leads to better outcomes. This review summarizes data addressing prognostic value of margin, extent of surgery necessary to optimize treatment of retroperitoneal sarcomas, and role of histology in optimizing therapy.

Local Control of Soft Tissue and Bone Sarcomas

“…Optimizing local control may improve disease-specific survival for retroperitoneal STS. [5][6][7][8] In an STS study demonstrating this, disease-specific mortality was caused by local recurrence without synchronous metastasis in 77% of patients with retroperitoneal STS, compared with only 9% of patients with extremity and trunk STS. 9 Because the completeness of resection is the primary determinant of local recurrence in retroperitoneal STS, there has been interest in extending surgical margins.…”

Huge retroperitoneal liposarcoma with renal involvement requires nephrectomy: A case report and literature review

“…Dedifferentiated and myxoid/round cell subtypes have 5-year survival rates of 75% and 60-90%, respectively (11). Since it is difficult to detect the retroperitoneal liposarcoma from adjacent normal fat, even if resection of the contiguous organ is performed, the rate of local recurrence is notably high, particularly in high-grade subtypes (12). In order to obtain the free margin, although the single or multi-organ resection may improve clinical outcome, the complication and the quality of life must be considered.…”

“…At a 6-month follow-up of the present case, no signs of metastasis or recurrence were observed. Previously, more and more investigations and case reports are inclined to preserve-organ surgery combined with neoadjuvant chemotherapy and radiotherapy to improve the clinical outcome (12)(13)(14). It is of great surprise that a new drug, Eribulin mesylate (Halaven), has been approved to treat non-resectable or metastasized liposarcoma (15).…”

Combined anterior‐posterior approach with enlarged sciatic foramen to remove sciatic notch dumbbell‐shaped tumors

“…Biopsy is a routine procedure before resection surgery in limb tumors. But for many retroperitoneal cases, if tumors can usually be ascertained by imaging characteristic, preoperative biopsy is unnecessary . And for tumors in complex anatomic situation, biopsy would bring contamination which was difficult to remove, if provisional diagnosis can be mainly made by MRI, biopsy before surgery is not required .…”