Faculty Collaboration Database

Consensus Guidelines on Perioperative Care in Primary Retroperitoneal Sarcoma Surgery. Ann Surg Oncol 2026 Jul;33(7):6881-6909

Date

04/13/2026

Pubmed ID

41973294

DOI

10.1245/s10434-026-19520-5

Scopus ID

2-s2.0-105036730531 (requires institutional sign-in at Scopus site)   1 Citation

Abstract

BACKGROUND: Primary retroperitoneal sarcomas (RPS) represent a rare group of malignancies requiring aggressive surgical management. While Enhanced Recovery After Surgery (ERAS) protocols have improved perioperative outcomes across many surgical disciplines, disease-specific guidance for RPS is lacking. This consensus aims to standardize perioperative care in primary RPS surgery on the basis of current evidence and expert opinion.

METHODS: A multidisciplinary panel of experts was convened under the auspices of the Spanish Society of Surgeons and the Portuguese Sarcoma Group. Between January and June 2025, a modified Delphi process was conducted, incorporating systematic literature review, subgroup synthesis, and four structured voting rounds. The strength of each recommendation was graded using the GRADE framework, and consensus was defined as ≥80% agreement among participants.

RESULTS: A total of 42 recommendations were proposed, addressing preoperative (e.g., anemia correction, smoking cessation, nutritional optimization), intraoperative (e.g., antimicrobial prophylaxis, goal-directed fluid therapy, multimodal analgesia), and postoperative care (e.g., ileus prevention, early feeding, opioid-sparing strategies, mobilization). In total, 33 recommendations reached consensus-17 with weak consensus and 16 with strong consensus-while 9 did not meet the predefined threshold. Most recommendations were supported by indirect evidence from major abdominal and oncologic surgery literature.

CONCLUSIONS: These are the first consensus-based, multidisciplinary perioperative care guidelines tailored to primary RPS surgery. They aim to harmonize clinical practice, reduce variation, and improve surgical and recovery outcomes in high-risk patients. Prospective validation and international collaboration are encouraged to further refine and implement these recommendations.

Author List

Lominchar PL, Díaz-Cambronero Ó, Muñoz-Muñoz P, Fernández-Candela A, Hernández-Sánchez P, Javaloyes N, Olivares V, Rodrigues CC, Prieto Nieto I, Díaz-Gómez D, Ibañez CB, Pinto P, Marrero-Marrero P, López M, Vallejo I, Sanz MC, Videira F, Martins P, Orbis P, Rubio A, Valderrama SO, Bermúdez F, Álvarez R, Roland CL, Lyu H, Clarke CN, Muñoz-Casares C, Asencio JM, Vasques H, Spanish Society of Surgeons and the Portuguese Sarcoma Group (Society of Surgeons)

Author

Callisia N. Clarke MD Chief, Associate Professor in the Surgery department at Medical College of Wisconsin

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

Consensus
Humans
Perioperative Care
Practice Guidelines as Topic
Retroperitoneal Neoplasms
Sarcoma