Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1998 Sep;228(3):355–365. doi: 10.1097/00000658-199809000-00008

Retroperitoneal soft-tissue sarcoma: analysis of 500 patients treated and followed at a single institution.

J J Lewis 1, D Leung 1, J M Woodruff 1, M F Brennan 1
PMCID: PMC1191491  PMID: 9742918

Abstract

OBJECTIVE: To analyze treatment and survival of a large cohort of patients with retroperitoneal soft-tissue sarcomas (STS) treated and prospectively followed at a single institution. SUMMARY BACKGROUND DATA: Retroperitoneal STS are relatively uncommon and constitute a difficult management problem. Although surgical resection is often difficult or impossible, current chemotherapy is not effective and radiation is limited by toxicity to adjacent structures. Thus, complete surgical resection remains the most effective modality for selected primary and recurrent disease. METHODS: Five hundred patients with retroperitoneal STS were admitted and treated between July 1, 1982, and September 30, 1997, and prospectively followed. Patient, tumor, and treatment variables were analyzed for disease-specific and disease-free survival. Survival was determined with the Kaplan-Meier method. Statistical significance was evaluated using the logrank test for univariate influence and Cox model stepwise regression for multivariate influence. RESULTS: Two hundred seventy-eight patients (56%) had primary disease and 222 (44%) recurrent disease. Median follow-up was 28 months (range 1 to 172 months), 40 months for survivors. Median survival was 72 months for patients with primary disease, 28 months for those with local recurrence, and 10 months for those with metastasis. For patients with primary or locally recurrent tumors, unresectable disease, incomplete resection, and high-grade tumors significantly reduced survival time. CONCLUSIONS: In this study of patients with retroperitoneal STS, stage at presentation, high histologic grade, unresectable primary tumor, and positive gross margin are strongly associated with the tumor mortality rate. Patients approached with curative intent should undergo aggressive attempts at complete surgical resection. Incomplete resection should be undertaken only for symptom relief.

Full text

PDF
355

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alvarenga J. C., Ball A. B., Fisher C., Fryatt I., Jones L., Thomas J. M. Limitations of surgery in the treatment of retroperitoneal sarcoma. Br J Surg. 1991 Aug;78(8):912–916. doi: 10.1002/bjs.1800780806. [DOI] [PubMed] [Google Scholar]
  2. Brennan M. F., Hilaris B., Shiu M. H., Lane J., Magill G., Friedrich C., Hajdu S. I. Local recurrence in adult soft-tissue sarcoma. A randomized trial of brachytherapy. Arch Surg. 1987 Nov;122(11):1289–1293. doi: 10.1001/archsurg.1987.01400230075014. [DOI] [PubMed] [Google Scholar]
  3. Clark J. A., Tepper J. E. Role of radiation therapy in retroperitoneal sarcomas. Oncology (Williston Park) 1996 Dec;10(12):1867–1874. [PubMed] [Google Scholar]
  4. Cody H. S., 3rd, Turnbull A. D., Fortner J. G., Hajdu S. I. The continuing challenge of retroperitoneal sarcomas. Cancer. 1981 May 1;47(9):2147–2152. doi: 10.1002/1097-0142(19810501)47:9<2147::aid-cncr2820470907>3.0.co;2-z. [DOI] [PubMed] [Google Scholar]
  5. Gaynor J. J., Tan C. C., Casper E. S., Collin C. F., Friedrich C., Shiu M., Hajdu S. I., Brennan M. F. Refinement of clinicopathologic staging for localized soft tissue sarcoma of the extremity: a study of 423 adults. J Clin Oncol. 1992 Aug;10(8):1317–1329. doi: 10.1200/JCO.1992.10.8.1317. [DOI] [PubMed] [Google Scholar]
  6. Hajdu S. I., Shiu M. H., Brennan M. F. The role of the pathologist in the management of soft tissue sarcomas. World J Surg. 1988 Jun;12(3):326–331. doi: 10.1007/BF01655665. [DOI] [PubMed] [Google Scholar]
  7. Harrison L. B., Franzese F., Gaynor J. J., Brennan M. F. Long-term results of a prospective randomized trial of adjuvant brachytherapy in the management of completely resected soft tissue sarcomas of the extremity and superficial trunk. Int J Radiat Oncol Biol Phys. 1993 Sep 30;27(2):259–265. doi: 10.1016/0360-3016(93)90236-o. [DOI] [PubMed] [Google Scholar]
  8. Jaques D. P., Coit D. G., Hajdu S. I., Brennan M. F. Management of primary and recurrent soft-tissue sarcoma of the retroperitoneum. Ann Surg. 1990 Jul;212(1):51–59. doi: 10.1097/00000658-199007000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Karakousis C. P., Gerstenbluth R., Kontzoglou K., Driscoll D. L. Retroperitoneal sarcomas and their management. Arch Surg. 1995 Oct;130(10):1104–1109. doi: 10.1001/archsurg.1995.01430100082016. [DOI] [PubMed] [Google Scholar]
  10. Karakousis C. P., Kontzoglou K., Driscoll D. L. Resectability of retroperitoneal sarcomas: a matter of surgical technique? Eur J Surg Oncol. 1995 Dec;21(6):617–622. doi: 10.1016/s0748-7983(95)95305-1. [DOI] [PubMed] [Google Scholar]
  11. Kilkenny J. W., 3rd, Bland K. I., Copeland E. M., 3rd Retroperitoneal sarcoma: the University of Florida experience. J Am Coll Surg. 1996 Apr;182(4):329–339. [PubMed] [Google Scholar]
  12. Kinsella T. J., Sindelar W. F., Lack E., Glatstein E., Rosenberg S. A. Preliminary results of a randomized study of adjuvant radiation therapy in resectable adult retroperitoneal soft tissue sarcomas. J Clin Oncol. 1988 Jan;6(1):18–25. doi: 10.1200/JCO.1988.6.1.18. [DOI] [PubMed] [Google Scholar]
  13. Leibel S. A., Tranbaugh R. F., Wara W. M., Beckstead J. H., Bovill E. G., Phillips T. L. Soft tissue sarcomas of the extremities: survival and patterns of failure with conservative surgery and postoperative irradiation compared to surgery alone. Cancer. 1982 Sep 15;50(6):1076–1083. doi: 10.1002/1097-0142(19820915)50:6<1076::aid-cncr2820500610>3.0.co;2-u. [DOI] [PubMed] [Google Scholar]
  14. Lewis J. J., Benedetti F. Adjuvant therapy for soft tissue sarcomas. Surg Oncol Clin N Am. 1997 Oct;6(4):847–862. [PubMed] [Google Scholar]
  15. Lewis J. J., Brennan M. F. Soft tissue sarcomas. Curr Probl Surg. 1996 Oct;33(10):817–872. [PubMed] [Google Scholar]
  16. Lewis J. J., Houghton A. N. Definition of tumor antigens suitable for vaccine construction. Semin Cancer Biol. 1995 Dec;6(6):321–327. doi: 10.1016/1044-579x(95)90001-2. [DOI] [PubMed] [Google Scholar]
  17. Lewis J. J., Leung D., Heslin M., Woodruff J. M., Brennan M. F. Association of local recurrence with subsequent survival in extremity soft tissue sarcoma. J Clin Oncol. 1997 Feb;15(2):646–652. doi: 10.1200/JCO.1997.15.2.646. [DOI] [PubMed] [Google Scholar]
  18. Lindberg R. D., Martin R. G., Romsdahl M. M., Barkley H. T., Jr Conservative surgery and postoperative radiotherapy in 300 adults with soft-tissue sarcomas. Cancer. 1981 May 15;47(10):2391–2397. doi: 10.1002/1097-0142(19810515)47:10<2391::aid-cncr2820471012>3.0.co;2-b. [DOI] [PubMed] [Google Scholar]
  19. McGrath P. C., Neifeld J. P., Lawrence W., Jr, DeMay R. M., Kay S., Horsley J. S., 3rd, Parker G. A. Improved survival following complete excision of retroperitoneal sarcomas. Ann Surg. 1984 Aug;200(2):200–204. doi: 10.1097/00000658-198408000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. PACK G. T., TABAH E. J. Primary retroperitoneal tumors: a study of 120 cases. Int Abstr Surg. 1954 Sep;99(3):209–contd. [PubMed] [Google Scholar]
  21. Potter D. A., Glenn J., Kinsella T., Glatstein E., Lack E. E., Restrepo C., White D. E., Seipp C. A., Wesley R., Rosenberg S. A. Patterns of recurrence in patients with high-grade soft-tissue sarcomas. J Clin Oncol. 1985 Mar;3(3):353–366. doi: 10.1200/JCO.1985.3.3.353. [DOI] [PubMed] [Google Scholar]
  22. Rosenberg S. A., Kent H., Costa J., Webber B. L., Young R., Chabner B., Baker A. R., Brennan M. F., Chretien P. B., Cohen M. H. Prospective randomized evaluation of the role of limb-sparing surgery, radiation therapy, and adjuvant chemoimmunotherapy in the treatment of adult soft-tissue sarcomas. Surgery. 1978 Jul;84(1):62–69. [PubMed] [Google Scholar]
  23. Russo P., Kim Y., Ravindran S., Huang W., Brennan M. F. Nephrectomy during operative management of retroperitoneal sarcoma. Ann Surg Oncol. 1997 Jul-Aug;4(5):421–424. doi: 10.1007/BF02305556. [DOI] [PubMed] [Google Scholar]
  24. Singer S., Corson J. M., Demetri G. D., Healey E. A., Marcus K., Eberlein T. J. Prognostic factors predictive of survival for truncal and retroperitoneal soft-tissue sarcoma. Ann Surg. 1995 Feb;221(2):185–195. doi: 10.1097/00000658-199502000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Storm F. K., Eilber F. R., Mirra J., Morton D. L. Retroperitoneal sarcomas: a reappraisal of treatment. J Surg Oncol. 1981;17(1):1–7. doi: 10.1002/jso.2930170102. [DOI] [PubMed] [Google Scholar]
  26. Storm F. K., Mahvi D. M. Diagnosis and management of retroperitoneal soft-tissue sarcoma. Ann Surg. 1991 Jul;214(1):2–10. doi: 10.1097/00000658-199107000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Suit H. D., Mankin H. J., Wood W. C., Proppe K. H. Preoperative, intraoperative, and postoperative radiation in the treatment of primary soft tissue sarcoma. Cancer. 1985 Jun 1;55(11):2659–2667. doi: 10.1002/1097-0142(19850601)55:11<2659::aid-cncr2820551122>3.0.co;2-q. [DOI] [PubMed] [Google Scholar]
  28. Tepper J. E., Suit H. D., Wood W. C., Proppe K. H., Harmon D., McNulty P. Radiation therapy of retroperitoneal soft tissue sarcomas. Int J Radiat Oncol Biol Phys. 1984 Jun;10(6):825–830. doi: 10.1016/0360-3016(84)90383-3. [DOI] [PubMed] [Google Scholar]
  29. Ueda T., Aozasa K., Tsujimoto M., Hamada H., Hayashi H., Ono K., Matsumoto K. Multivariate analysis for clinical prognostic factors in 163 patients with soft tissue sarcoma. Cancer. 1988 Oct 1;62(7):1444–1450. doi: 10.1002/1097-0142(19881001)62:7<1444::aid-cncr2820620733>3.0.co;2-l. [DOI] [PubMed] [Google Scholar]
  30. Willett C. G., Suit H. D., Tepper J. E., Mankin H. J., Convery K., Rosenberg A. L., Wood W. C. Intraoperative electron beam radiation therapy for retroperitoneal soft tissue sarcoma. Cancer. 1991 Jul 15;68(2):278–283. doi: 10.1002/1097-0142(19910715)68:2<278::aid-cncr2820680211>3.0.co;2-c. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES