Nessim Carolyn, Raut Chandrajit P, Callegaro Dario, Barretta Francesco, Miceli Rosalba, Fairweather Mark, Rutkowski Piotr, Blay Jean-Yves, Strauss Dirk, Gonzalez Ricardo, Ahuja Nita, Grignani Giovanni, Quagliuolo Vittorio, Stoeckle Eberhard, De Paoli Antonino, Pillarisetty Venu G, Swallow Carol J, Bagaria Sanjay P, Canter Robert J, Mullen John T, Schrage Yvonne, Pennacchioli Elisabetta, van Houdt Winan, Cardona Kenneth, Fiore Marco, Gronchi Alessandro, Lahat Guy
Department of Surgery, The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
Department of Surgery, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, USA.
Ann Surg Oncol. 2021 May;28(5):2705-2714. doi: 10.1245/s10434-020-09445-y. Epub 2021 Jan 2.
This study aimed to evaluate perioperative morbidity after surgery for first locally recurrent (LR1) retroperitoneal sarcoma (RPS). Data concerning the safety of resecting recurrent RPS are lacking.
Data were collected on all patients undergoing resection of RPS-LR1 at 22 Trans-Atlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG) centers from 2002 to 2011. Uni- and multivariable logistic models were fitted to study the association between major (Clavien-Dindo grade ≥ 3) complications and patient/surgery characteristics as well as outcome. The resected organ score, a method of standardizing the number of organs resected, as previously described by the TARPSWG, was used.
The 681 patients in this study had a median age of 59 years, and 51.8% were female. The most common histologic subtype was de-differentiated liposarcoma (43%), the median resected organ score was 1, and 83.3% of the patients achieved an R0 or R1 resection. Major complications occurred for 16% of the patients, and the 90-day mortality rate was 0.4%. In the multivariable analysis, a transfusion requirement was found to be a significant predictor of major complications (p < 0.001) and worse overall survival (OS) (p = 0.010). However, having a major complication was not associated with a worse OS or a higher incidence of local recurrence or distant metastasis.
A surgical approach to recurrent RPS is relatively safe and comparable with primary RPS in terms of complications and postoperative mortality when performed at specialized sarcoma centers. Because alternative effective therapies still are lacking, when indicated, resection of a recurrent RPS is a reasonable option. Every effort should be made to minimize the need for blood transfusions.
本研究旨在评估首次局部复发（LR1）的腹膜后肉瘤（RPS）手术后的围手术期发病率。目前缺乏有关复发性RPS切除安全性的数据。
收集了2002年至2011年在22个跨大西洋澳大拉西亚腹膜后肉瘤工作组（TARPSWG）中心接受RPS-LR1切除手术的所有患者的数据。采用单变量和多变量逻辑模型研究主要（Clavien-Dindo分级≥3级）并发症与患者/手术特征以及预后之间的关联。使用了TARPSWG先前描述的切除器官评分法，该方法用于标准化切除器官的数量。
本研究中的681例患者中位年龄为59岁，51.8%为女性。最常见的组织学亚型是去分化脂肪肉瘤（43%），中位切除器官评分为1，83.3%的患者实现了R0或R1切除。16%的患者发生了主要并发症，90天死亡率为0.4%。在多变量分析中，发现输血需求是主要并发症（p<0.001）和较差总生存期（OS）（p=0.010）的显著预测因素。然而，发生主要并发症与较差的OS、较高的局部复发或远处转移发生率无关。
在专门的肉瘤中心进行手术时，复发性RPS的手术方法相对安全，在并发症和术后死亡率方面与原发性RPS相当。由于仍然缺乏其他有效的治疗方法，在有指征时，复发性RPS的切除是一个合理的选择。应尽一切努力尽量减少输血需求。
