Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
PLoS One. 2022 Jul 28;17(7):e0272044. doi: 10.1371/journal.pone.0272044. eCollection 2022.
Definitive evidence to guide clinical practice on the principles of surgery for retroperitoneal sarcomas (RPSs) is still lacking. This study aims to summarise the available evidence to assess the relative benefits and disadvantages of an aggressive surgical approach with contiguous organ resection in patients with RPS, the association between surgical resection margins and survival outcomes, and the role of surgery in recurrent RPS.
We searched PubMed, the Cochrane Library, and EMBASE for relevant randomised trials and observational studies published from inception up to May 1, 2021. Prospective or retrospective studies, published in the English language, providing outcome data with surgical treatment in patients with RPS were selected. The primary outcome was overall survival (OS).
In total, 47 articles were analysed. There were no significant differences in the rates of OS (HR: 0.93; 95% CI: 0.83-1.03; P = 0.574) and recurrence-free survival (HR: 1.00; 95% CI: 0.74-1.27; P = 0.945) between the extended resection group and the tumour resection alone group. Organ resection did not increase postoperative mortality (OR: 1.00; 95% CI: 0.55-1.81; P = 0.997) but had a relatively higher complication rate (OR: 2.24, 95% CI: 0.94-5.34; P = 0.068). OS was higher in R0 than in R1 resection (HR: 1.34; 95% CI: 1.23-1.44; P < 0.001) and in R1 resection than in R2 resection (HR: 1.86; 95% CI: 1.35-2.36; P < 0.001). OS was also higher in R2 resection than in no surgery (HR: 1.26; 95% CI: 1.07-1.45; P < 0.001), however, subgroup analysis showed that the pooled HR in the trials reporting primary RPS was similar between the two groups (HR, 1.14; 95% CI, 0.87-1.42; P = 0.42). Surgical treatment achieves a significantly higher OS rate than does conservative treatment (HR: 2.42; 95% CI: 1.21-3.64; P < 0.001) for recurrent RPS.
For primary RPS, curative-intent en bloc resection should be aimed, and adjacent organs with evidence of direct invasion must be resected to avoid R2 resection. For recurrent RPS, surgical resection should be considered as a priority. Incomplete resection remains to have a survival benefit in select patients with unresectable recurrent RPS.
指导腹膜后肉瘤（RPS）手术原则的临床实践的明确证据仍然缺乏。本研究旨在总结现有证据，评估在 RPS 患者中采用连续器官切除的积极手术方法的相对益处和弊端、手术切缘与生存结局之间的关联，以及手术在复发性 RPS 中的作用。
我们检索了 PubMed、Cochrane 图书馆和 EMBASE，以获取截至 2021 年 5 月 1 日发表的关于 RPS 患者接受手术治疗的随机试验和观察性研究的相关信息。选择了提供 RPS 患者手术治疗结果数据的前瞻性或回顾性研究，且研究语言为英文。主要结局为总生存（OS）。
共分析了 47 篇文章。在 OS（HR：0.93；95%CI：0.83-1.03；P=0.574）和无复发生存（HR：1.00；95%CI：0.74-1.27；P=0.945）方面，扩大切除术组与单纯肿瘤切除术组之间没有显著差异。器官切除并未增加术后死亡率（OR：1.00；95%CI：0.55-1.81；P=0.997），但并发症发生率相对较高（OR：2.24，95%CI：0.94-5.34；P=0.068）。R0 切除比 R1 切除（HR：1.34；95%CI：1.23-1.44；P<0.001）和 R2 切除（HR：1.86；95%CI：1.35-2.36；P<0.001）的 OS 更高。与未手术组相比，R2 切除的 OS 也更高（HR：1.26；95%CI：1.07-1.45；P<0.001），但亚组分析显示，报告原发性 RPS 的试验中两组之间的汇总 HR 相似（HR，1.14；95%CI，0.87-1.42；P=0.42）。与保守治疗相比，手术治疗在复发性 RPS 中具有更高的 OS 率（HR：2.42；95%CI：1.21-3.64；P<0.001）。
对于原发性 RPS，应旨在达到治愈性的整块切除术，并且对于有直接侵犯证据的相邻器官必须进行切除，以避免 R2 切除术。对于复发性 RPS，应考虑手术切除作为首选。对于选择的不可切除复发性 RPS 患者，不完全切除仍具有生存获益。
