Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
Department of Medical Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
J Surg Oncol. 2020 Jun;121(7):1140-1147. doi: 10.1002/jso.25890. Epub 2020 Mar 13.
Outcomes of palliative-intent surgery in retroperitoneal sarcomas (RPS) are not well understood. This study aims to define indications for and outcomes after palliative-intent RPS resection.
Using a retrospective 8-institution database, patients undergoing resection of primary/recurrent RPS with palliative intent were identified. Logistic regression and Cox-proportional hazards models were constructed to analyze factors associated with postoperative complications and overall survival (OS).
Of 3088 patients, 70 underwent 87 palliative-intent procedures. Most common indications were pain (26%) and bowel obstruction (21%). Dedifferentiated liposarcoma (n = 17, 24%), leiomyosarcoma (n = 13, 19%) were predominant subtypes. Median OS was 10.69 months (IQR, 3.91-23.23). R2 resection (OR, 8.60; CI, 1.42-52.15; P = .019), larger tumors (OR, 10.87; CI, 1.44-82.11; P = .021) and low preoperative albumin (OR, 0.14; CI, 0.04-0.57; P = .006) were associated with postoperative complications. Postoperative complications (HR, 1.95; CI, 1.02-3.71; P = .043) and high-grade histology (HR, 6.56; CI, 1.72-25.05; P = .006) rather than resection status were associated with reduced OS. However, in R2-resected patients, development of postoperative complications significantly reduced survival (P = .042).
Postoperative complications and high-grade histology rather than resection status impacts survival in palliative-intent RPS resections. Given the higher incidence of postoperative complications which may diminish survival, palliative-intent R2 resection should be offered only after cautious consideration.
姑息性手术治疗腹膜后肉瘤（RPS）的预后尚不明确。本研究旨在确定 RPS 行姑息性手术的适应证和预后。
本研究回顾性分析了 8 家机构的数据库，纳入了行姑息性 RPS 切除术的患者。使用逻辑回归和 Cox 比例风险模型分析了与术后并发症和总生存期（OS）相关的因素。
在 3088 例患者中，70 例行 87 次姑息性手术。最常见的手术指征为疼痛（26%）和肠梗阻（21%）。去分化脂肪肉瘤（n=17，24%）和 leiomyosarcoma（n=13，19%）是最常见的组织学亚型。中位 OS 为 10.69 个月（IQR，3.91-23.23）。R2 切除（OR，8.60；95%CI，1.42-52.15；P=0.019）、肿瘤较大（OR，10.87；95%CI，1.44-82.11；P=0.021）和术前白蛋白水平较低（OR，0.14；95%CI，0.04-0.57；P=0.006）与术后并发症相关。术后并发症（HR，1.95；95%CI，1.02-3.71；P=0.043）和高级别组织学（HR，6.56；95%CI，1.72-25.05；P=0.006）而非切除范围与 OS 降低相关。然而，在 R2 切除患者中，术后并发症的发生显著降低了生存（P=0.042）。
术后并发症和高级别组织学而非切除范围影响 RPS 姑息性切除术患者的生存。鉴于术后并发症发生率较高可能会降低生存率，R2 切除的姑息性治疗应在谨慎考虑后施行。
