Highlights
- -Adequate imaging and biopsy are crucial for diagnosis and planning surgical approach
- -Histologic subtypes are different in pelvic sarcomas compared to retroperitoneal
- -Multimodal treatment is frequently adopted at referral centers
- -Pelvic anatomy impacts functional outcome and decision for preoperative therapy
- -Benefit from referral to high volume centers and histology driven tailored approach
Abstract
Pelvic soft tissue sarcomas (PSTS) are a rare, heterogeneous group of tumors. They
have been usually analyzed with retroperitoneal sarcomas (RPS), but actually have
key differences. Due to their unique anatomic location, symptomatic presentation of
PSTS may be more common than RPS. Adequate imaging approach is paramount for guiding
differential diagnosis, while preoperative biopsy is mandatory, especially when preoperative
treatment may be considered as initial approach. The most frequent histologic subtype
is leiomyosarcoma, which is different as expected in the retroperitoneum where liposarcoma
is the commonest histology. Also solitary fibrous tumor is commonly diagnosed in the
pelvis. Surgical approach for PSTS differs from that for RPS mainly due to anatomic
relations. Similarly, in the lack of definite evidence from specific trials about
neoadjuvant and adjuvant treatments, the anatomic constraints to obtain wide margins
in the pelvis as well as the expected functional outcome in case of organ resections
should be factored into decision for individualized treatment offer. Vascular and
genitourinary involvement are frequent, as well as herniation through pelvic foramina.
For these reasons a multidisciplinary surgical team should always be considered. Early
referral of these patients to high-volume centers is critical and may impact on survival,
given that optimal initial resection is a major predictor of curative treatment. International
consensus on PSTS treatment is advocated, similarly to the recent efforts realized
for RPS.
Keywords
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Article info
Publication history
Published online: June 04, 2022
Accepted:
June 1,
2022
Received in revised form:
May 28,
2022
Received:
December 12,
2021
Identification
Copyright
© 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
