This special issue of the European Journal of Surgical Oncology focuses on retroperitoneal sarcomas (RPS), one of the most challenging issues in
surgical oncology. We present here a series of review manuscripts regarding the major
controversies, drafted by multidisciplinary experts under the auspices of the Transatlantic
Australasian Retroperitoneal Sarcoma Working Group (TARPSWG), and we thank all authors
for their commitment. The only potentially curative treatment of RPS is macroscopically
en bloc complete resection at the time of the first surgery. This goal can only be achieved
after a correct diagnosis [
[1]
], a careful assessment of the tumor extension on imaging [
[2]
], and a comprehensive discussion by the multidisciplinary tumor board (MDT) [
[3]
,
[4]
] ahead of surgery and carrying out the operation in reference centers. This structured
approach may lead to prolonged survival which has been improved during the past 15
years, as a consequence of better patient selection and improved quality of surgery
and perioperative management [
[5]
]. There are several constraints for an extensive surgical approach in the retroperitoneal
space: RPS are usually large and adjacent to vital organs. Anatomical limitations
often lead to marginal resection. Treatments should be individualized according to
specific histiotypes [
- Callegaro D.
- Raut C.P.
- Ng D.
- Strauss D.C.
- Honoré C.
- Stoeckle E.
- et al.
Has the outcome for patients who undergo resection of primary retroperitoneal sarcoma
changed over time? A study of time trends during the past 15 years.
Ann Surg Oncol. 2021 Mar; 28 (Epub 2020 Oct 18. PMID: 33073340): 1700-1709https://doi.org/10.1245/s10434-020-09065-6
[4]
], particularly for well-differentiated liposarcoma (WD LPS) and grade 2 dedifferentiated
liposarcomas (DD LPS) where local control is the driver of the outcome [
[6]
]. In these subtypes, an extended surgical approach has been proven to associate to
a better local control and superior overall survival in retrospective series [
[7]
,
Trans-Atlantic RPS Working Group
Management of primary retroperitoneal sarcoma (RPS) in the adult: a consensus approach from the Trans-Atlantic RPS Working Group.
Management of primary retroperitoneal sarcoma (RPS) in the adult: a consensus approach from the Trans-Atlantic RPS Working Group.
Ann Surg Oncol. 2015 Jan; 22 (Epub 2014 Oct 15. PMID: 25316486): 256-263https://doi.org/10.1245/s10434-014-3965-2
[8]
]. In most cases this is achieved by multivisceral resection with removal of the whole
fatty tissue. The most frequently resected organs are the kidney, the colon along
the tumor front, and the aponeurosis of muscles in the tumor back. Such extended resections
are safe when performed at centers of excellence [
[9]
]; however a retrospective analysis demonstrated how pancreatectomy/pancreatico-duodenectomy,
major vascular resections and splenectomy were found to increase the operative risk
(with odds ratio >1.5), limiting their resection to macroscopic involvement [
[10]
].To read this article in full you will need to make a payment
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References
Watson S et al. New developments in the pathology and molecular biology of retroperitoneal sarcomas. Eur J Surg Oncol, 2023;49(6):1053-60.
- Improved survival using specialized multidisciplinary board in sarcoma patients.Ann Oncol. 2017 Nov 1; 28: 2852-2859
- Management of primary retroperitoneal sarcoma (RPS) in the adult: an updated consensus approach from the transatlantic australasian RPS working Group.Ann Surg Oncol. 2021 Nov; 28: 7873-7888
Bonvalot et al. Histology-tailored multidisciplinary management of primary retroperitoneal sarcomas. Eur J Surg Oncol, 2023;49(6):1061-7.
- Has the outcome for patients who undergo resection of primary retroperitoneal sarcoma changed over time? A study of time trends during the past 15 years.Ann Surg Oncol. 2021 Mar; 28 (Epub 2020 Oct 18. PMID: 33073340): 1700-1709https://doi.org/10.1245/s10434-020-09065-6
- Variability in patterns of recurrence after resection of primary retroperitoneal sarcoma (RPS): a report on 1007 patients from the multi-institutional collaborative RPS working Group.Ann Surg. 2016 May; 263 (PMID: 26727100): 1002-1009https://doi.org/10.1097/SLA.0000000000001447
- Management of primary retroperitoneal sarcoma (RPS) in the adult: a consensus approach from the Trans-Atlantic RPS Working Group.Ann Surg Oncol. 2015 Jan; 22 (Epub 2014 Oct 15. PMID: 25316486): 256-263https://doi.org/10.1245/s10434-014-3965-2
- Variability in patterns of recurrence after resection of primary retroperitoneal sarcoma (RPS): a report on 1007 patients from the Multi-institutional Collaborative RPS Working Group.Ann Surg. 2016; 263: 1002-1009
- Postoperative morbidity after radical resection of primary retroperitoneal sarcoma: a report from the transatlantic RPS working Group.Ann Surg. 2018 May; 267: 959-964
- Postoperative morbidity after radical resection of primary retroperitoneal sarcoma: a report from the transatlantic RPS working Group.Ann Surg. 2018 May; 267 (PMID: 28394870): 959-964https://doi.org/10.1097/SLA.0000000000002250
Gronchi A et al. How to treat liposarcomas located in retroperitoneum. Eur J Surg Oncol, 2023;49(6):1068-80.
- Histology-based classification predicts pattern of recurrence and improves risk stratification in primary retroperitoneal sarcoma.Ann Surg. 2016; 263: 593-600
Raut et al. Special clinical scenarios in RPS: involvement of great vessels, pancreas and penetration cross natural foramens. Eur J Surg Oncol, 2023;49(6):1091-101.
Tseng W. et al. Current management of benign retroperitoneal tumour. Eur J Surg Oncol, 2023;49(6):1081-90.
- Pelvic soft tissue sarcomas.Eur J Surg Oncol. 2022; (In press)https://doi.org/10.1016/j.ejso.2022.06.003
Siew et al. Management of recurrent retroperitoneal sarcomas. Eur J Surg Oncol, 2023;49(6):1115-24.
- Analysis of differentiation changes and outcomes at time of first recurrence of retroperitoneal liposarcoma by transatlantic australasian retroperitoneal sarcoma working Group (TARPSWG).Ann Surg Oncol. 2021 Nov; 28 (Epub 2021 Apr 27. PMID: 33907921): 7854-7863https://doi.org/10.1245/s10434-021-10024-y
Wiltink et al. The role of standard and novel radiotherapy approaches in management of retroperitoneal sarcomas. Eur J Surg Oncol 2023;49(6):1111-4.
Kasper B et al. Standard medical treatment and new options in retroperitoneal sarcoma. Eur J Surg Oncol 2023;49(6):1133-9.
- Preoperative radiotherapy plus surgery versus surgery alone for patients with primary retroperitoneal sarcoma (EORTC-62092: STRASS): a multicentre, open-label, randomised, phase 3 trial.Lancet Oncol. 2020; 21: 1366-1377
Article info
Publication history
Published online: September 14, 2022
Accepted:
September 7,
2022
Received:
September 7,
2022
Identification
Copyright
© 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
