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Outcomes of palliative-intent surgery in retroperitoneal sarcoma-Results from the US Sarcoma Collaborative. J Surg Oncol 2020 Jun;121(7):1140-1147

Date

03/14/2020

Pubmed ID

32167587

DOI

10.1002/jso.25890

Scopus ID

2-s2.0-85081732672

Abstract

BACKGROUND AND OBJECTIVES: 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.

METHODS: 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).

RESULTS: 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).

CONCLUSIONS: 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.

Author List

Thalji SZ, Tsai S, Gamblin TC, Clarke C, Christians K, Charlson J, Ethun CG, Poultsides G, Grignol VP, Roggin KK, Votanopoulos K, Fields RC, Abbott DE, Cardona K, Mogal H, other members of the US Sarcoma Collaborative

Authors

John A. Charlson MD Associate Professor in the Medicine department at Medical College of Wisconsin
Kathleen K. Christians MD Professor in the Surgery department at Medical College of Wisconsin
Callisia N. Clarke MD Assistant Professor in the Surgery department at Medical College of Wisconsin
Thomas Clark Gamblin MD Chief, Professor in the Surgery department at Medical College of Wisconsin
Susan Tsai MD Associate Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Aged
Cancer Pain
Databases, Factual
Female
Humans
Intestinal Obstruction
Male
Middle Aged
Palliative Care
Postoperative Complications
Retroperitoneal Neoplasms
Retrospective Studies
Sarcoma
Survival Analysis
Treatment Outcome
United States