Originally published as JCO Early Release 10.1200/JCO.2008.18.0802 on December 1 2008

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Primary Retroperitoneal Sarcomas: A Multivariate Analysis of Surgical Factors Associated With Local Control

Sylvie Bonvalot, Michel Rivoire, Marine Castaing, Eberhard Stoeckle, Axel Le Cesne, Jean Yves Blay, Agnès Laplanche

From the Departments of Surgery, Public Health, and Medical Oncology, Institut Gustave-Roussy, Villejuif; Department of Surgery, Medical Oncology Centre Léon Bérard, Lyon; and Department of Surgery, Institut Bergonié, Bordeaux, France

Corresponding author: Sylvie Bonvalot, MD, PhD, Department of Surgery, Institut Gustave-Roussy, 39 rue Camille Desmoulins 94805 Villejuif Cedex France; e-mail: bonvalot{at}igr.fr

Purpose To define the optimal initial management and the best extent of surgery that would optimize margins on primary retroperitoneal sarcomas (RPS).

Patients and Methods A total of 382 patients with primary RPS were analyzed. Sixty-five patients had a simple resection of the tumor, 120 patients had a complete compartmental resection (systematic resection of noninvolved contiguous organs), 130 patients had a contiguously involved organ resection, 21 patients had a systematic re-excision, 38 patients had an incomplete gross resection, and eight patients had a biopsy alone. Radiotherapy and chemotherapy were administered to 121 and 145 patients, respectively.

Results One, 3-, and 5-year overall survival (OS) rates were 86% (95% CI, 0.82 to 0.89), 66% (95% CI, 0.61 to 0.71), and 57% (95% CI, 0.51 to 0.62), respectively. Median overall survival was 6 years. In the multivariate analysis, high grade, tumor rupture, gross residual disease, and positive margins were associated with decreased OS. Low grade, no tumor rupture, negative histologic margins, a high number of patients undergoing operation per center, and compartmental resection compared with standard procedures were associated with decreased abdominal recurrences. Compartmental resection is a significant variable, predicting a 3.29-fold lower rate of abdominal recurrence compared with simple complete resection.

Conclusion Complete compartmental surgery without tumor rupture should be performed when possible to achieve clear margins. This surgery should be performed in a high-volume center. The role of adjuvant treatments should be evaluated in a randomized trial in association with this optimal surgery.

published online ahead of print at www.jco.org on December 1, 2008

Written on behalf of the French Association of Surgery.

Presented at the 12th Connective Tissue Oncology Society meeting, November 2-4, 2006; and the 43rd Annual Meeting of the American Society of Clinical Oncology, June 1-5, 2007, Chicago, IL.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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