• Andrea J MacNeill, Alessandro Gronchi, Rosalba Miceli, Sylvie Bonvalot, Carol J Swallow, Peter Hohenberger, Frits Van Coevorden, Piotr Rutkowski, Dario Callegaro, Andrew J Hayes, Charles Honoré, Mark Fairweather, Amanda Cannell, Jens Jakob, Rick L Haas, Milena Szacht, Marco Fiore, Paolo G Casali, Raphael E Pollock, Francesco Barretta, Chandrajit P Raut, and Dirk C Strauss.
• Department of Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Center, Department of Surgery, University of Toronto, Toronto, Canada.
• Ann. Surg. 2018 May 1; 267 (5): 959-964.

ObjectiveTo investigate the safety of radical resection for retroperitoneal sarcoma (RPS).BackgroundThe surgical management of RPS frequently involves complex multivisceral resection. Improved oncologic outcomes have been demonstrated with this approach compared to marginal excision, but the safety of radical resection has not been shown in a large study population.MethodsThe Transatlantic Retroperitoneal Sarcoma Working Group (TARPSWG) is an international collaborative of sarcoma centers. A combined experience of 1007 consecutive resections for primary RPS from January 2002 to December 2011 was studied retrospectively with respect to adverse events. A weighted organ score was devised to account for differences in surgical complexity. Univariate and multivariate logistic regression analyses were performed to investigate associations between adverse events and number and patterns of organs resected. Associations between adverse events and overall survival, local recurrence, and distant metastases were investigated.ResultsSevere postoperative adverse events (Clavien-Dindo ≥3) occurred in 165 patients (16.4%) and 18 patients (1.8%) died within 30 days. Significant predictors of severe adverse events were age (P = 0.003), transfusion requirements (P < 0.001), and resected organ score (P = 0.042). Resections involving pancreaticoduodenectomy, major vascular resection, and splenectomy/pancreatectomy were found to entail higher operative risk (odds ratio >1.5). There was no impact of postoperative adverse events on overall survival, local recurrence, or distant metastases.ConclusionsA radical surgical approach to RPS is safe when carried out at a specialist sarcoma center. High-risk resections should be carefully considered on an individual basis and weighed against anticipated disease biology. There appears to be no association between surgical morbidity and long-term oncologic outcomes.

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