Postoperative Morbidity After Resection of Recurrent Retroperitoneal Sarcoma: A Report from the Transatlantic Australasian RPS Working Group (TARPSWG).
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
May 2021
May 2021
Historique:
received:
13
06
2020
accepted:
13
10
2020
pubmed:
4
1
2021
medline:
15
5
2021
entrez:
3
1
2021
Statut:
ppublish
Résumé
This study aimed to evaluate perioperative morbidity after surgery for first locally recurrent (LR1) retroperitoneal sarcoma (RPS). Data concerning the safety of resecting recurrent RPS are lacking. Data were collected on all patients undergoing resection of RPS-LR1 at 22 Trans-Atlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG) centers from 2002 to 2011. Uni- and multivariable logistic models were fitted to study the association between major (Clavien-Dindo grade ≥ 3) complications and patient/surgery characteristics as well as outcome. The resected organ score, a method of standardizing the number of organs resected, as previously described by the TARPSWG, was used. The 681 patients in this study had a median age of 59 years, and 51.8% were female. The most common histologic subtype was de-differentiated liposarcoma (43%), the median resected organ score was 1, and 83.3% of the patients achieved an R0 or R1 resection. Major complications occurred for 16% of the patients, and the 90-day mortality rate was 0.4%. In the multivariable analysis, a transfusion requirement was found to be a significant predictor of major complications (p < 0.001) and worse overall survival (OS) (p = 0.010). However, having a major complication was not associated with a worse OS or a higher incidence of local recurrence or distant metastasis. A surgical approach to recurrent RPS is relatively safe and comparable with primary RPS in terms of complications and postoperative mortality when performed at specialized sarcoma centers. Because alternative effective therapies still are lacking, when indicated, resection of a recurrent RPS is a reasonable option. Every effort should be made to minimize the need for blood transfusions.
Sections du résumé
BACKGROUND
BACKGROUND
This study aimed to evaluate perioperative morbidity after surgery for first locally recurrent (LR1) retroperitoneal sarcoma (RPS). Data concerning the safety of resecting recurrent RPS are lacking.
METHODS
METHODS
Data were collected on all patients undergoing resection of RPS-LR1 at 22 Trans-Atlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG) centers from 2002 to 2011. Uni- and multivariable logistic models were fitted to study the association between major (Clavien-Dindo grade ≥ 3) complications and patient/surgery characteristics as well as outcome. The resected organ score, a method of standardizing the number of organs resected, as previously described by the TARPSWG, was used.
RESULTS
RESULTS
The 681 patients in this study had a median age of 59 years, and 51.8% were female. The most common histologic subtype was de-differentiated liposarcoma (43%), the median resected organ score was 1, and 83.3% of the patients achieved an R0 or R1 resection. Major complications occurred for 16% of the patients, and the 90-day mortality rate was 0.4%. In the multivariable analysis, a transfusion requirement was found to be a significant predictor of major complications (p < 0.001) and worse overall survival (OS) (p = 0.010). However, having a major complication was not associated with a worse OS or a higher incidence of local recurrence or distant metastasis.
CONCLUSIONS
CONCLUSIONS
A surgical approach to recurrent RPS is relatively safe and comparable with primary RPS in terms of complications and postoperative mortality when performed at specialized sarcoma centers. Because alternative effective therapies still are lacking, when indicated, resection of a recurrent RPS is a reasonable option. Every effort should be made to minimize the need for blood transfusions.
Identifiants
pubmed: 33389288
doi: 10.1245/s10434-020-09445-y
pii: 10.1245/s10434-020-09445-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2705-2714Commentaires et corrections
Type : CommentIn
Type : ErratumIn
Références
Erzen D, Sencar M, Novak J. Retroperitoneal sarcoma: 25 years of experience with aggressive surgical treatment at the Institute of Oncology, Ljubljana. J Surg Oncol. 2005;91:1–9.
doi: 10.1002/jso.20265
Lewis JJ, LeungD, Woodruff JM, et al. Retroperitoneal sarcoma: analysis of 500 patients treated and followed at a single institution. Ann Surg. 1998;228:355.
doi: 10.1097/00000658-199809000-00008
Gronchi A, Strauss DC, Miceli R, et al. Variability in patterns of recurrence after resection of primary retroperitoneal sarcoma (RPS): a report on 1007 patients from the Multi-Institutional Collaborative RPS Working Group. Ann Surg. 2016;263:1002–9.
doi: 10.1097/SLA.0000000000001447
TARPSWG. Management of recurrent retroperitoneal sarcoma (RPS): a consensus approach from the Trans-Atlantic RPS Working Group. Ann Surg Oncol. 2016;23:3531–40.
doi: 10.1245/s10434-016-5336-7
MacNeill AJ, Gronchi A, Micelli R, et al. Postoperative morbidity after radical resection of primary retroperitoneal sarcoma a report from the Transatlantic RPS Working Group. Ann Surg Oncol. 2017;24:688–9.
doi: 10.1245/s10434-017-5889-0
Gronchi A, Miceli R, Allard MA, et al. Personalizing the approach to retroperitoneal soft tissue sarcoma: histology-specific patterns of failure and post-relapse outcome after primary extended resection. Ann Surg Oncol. 2015;22:1447–54.
doi: 10.1245/s10434-014-4130-7
Tan MC, Brennan MF, Kuk D, et al. Histology-based classification predicts pattern of recurrence and improves risk stratification in primary retroperitoneal sarcoma. Ann Surg. 2016;263:593–600.
doi: 10.1097/SLA.0000000000001149
Singer S, Anotnescu CR, Riedel E, Brennan MF. Histologic subtype and margin of resection predict pattern of recurrence and survival for retroperitoneal liposarcoma. Ann Surg. 2003;238:358–70.
doi: 10.1097/01.sla.0000086542.11899.38
Gyorki DE, Brennan MF. Management of recurrent retroperitoneal sarcoma. J Surg Oncol. 2014;109:53–9.
doi: 10.1002/jso.23463
Raut CP, Callegro D, Miceli R, et al. Predicting survival in patients undergoing resection for locally recurrent retroperitoneal sarcoma: a study and novel nomogram from TARPSWG. Clin Cancer Res. 2019;25:2664–71.
doi: 10.1158/1078-0432.CCR-18-2700
Durrleman S, Simon R. Flexible regression models with cubic splines. Stat Med. 1989;8:551–61.
doi: 10.1002/sim.4780080504
Peacock O, Patel S, Simpson JA, et al. A systematic review of population-based studies examining outcomes in primary retroperitoneal sarcoma surgery. Surg Oncol. 2019;29:53–63.
doi: 10.1016/j.suronc.2019.03.002
Judge SJ, Lata-Arias K, Yanagisawa M, et al. Morbidity, mortality, and temporal trends in the surgical management of retroperitoneal sarcoma: an ACS-NSQIP follow-up analysis. J Surg Oncol. 2019;120:753–60.
pubmed: 31355444
pmcid: 31355444
MacNeill AJ, Miceli R, Strauss D, et al. Post-relapse outcomes after primary extended resection of retroperitoneal sarcoma: a report from the Trans‐Atlantic RPS Working Group. Cancer 2017;123:1971–8.
doi: 10.1002/cncr.30572
Nizri E, Fiore M, Colombo CS, et al. Completion surgery of residual disease after primary inadequate surgery of retroperitoneal sarcomas achieves comparable oncological outcomes: a propensity score analysis. J Surg Oncol. 2019;119:318–23.
pubmed: 30554403
pmcid: 30554403
Weingart SN, Nelson J, Koethe B, et al. Developing a cancer-specific trigger tool to identify treatment-related adverse events using administrative data. Cancer Med. 2020. https://doi.org/10.1002/cam4.2812 .
doi: 10.1002/cam4.2812
pubmed: 32285614
pmcid: 32285614
Fisher OM, Alzahrani NA, Kozman MA, et al. Intraoperative packed red blood cell transfusion (iPRBT) and PCI-normalised iPRBT rates (iPRBT/PCI ratio) negatively affect short- and long-term outcomes of patients undergoing cytoreductive surgery and intraperitoneal chemotherapy: an analysis of 880 patients. Euro J Surg Oncol. 2019;45:2412–23.
doi: 10.1016/j.ejso.2019.07.031
Kwon HY, Kim BR, Kim YW. Association of preoperative anemia and perioperative allogenic red blood cell transfusion with oncologic outcomes in patients with nonmetastatic colorectal cancer. Curr Oncol. 2019;26:e357–66.
doi: 10.3747/co.26.4983
Iwata T, Kimura S, Foerster B, et al. Perioperative blood transfusion affects oncologic outcomes after nephrectomy for renal cell carcinoma: a systematic review and meta-analysis. Urol Oncol. 2019;37:273–81.
doi: 10.1016/j.urolonc.2019.01.018
Liu X, Ma M, et al. Effect of perioperative blood transfusion on prognosis of patients with gastric cancer: a retrospective analysis of a single center database. BMC Cancer. 2018;18:649.
doi: 10.1186/s12885-018-4574-4
Mavros MN, Xu L, Masgood H, et al. Perioperative blood transfusion and the prognosis of pancreatic cancer surgery: systematic review and meta-analysis. Ann Surg Oncol. 2015;22:4382–91.
doi: 10.1245/s10434-015-4823-6
Wada H, Eguchi H, Nagano H, et al. Perioperative allogenic blood transfusion is a poor prognostic factor after hepatocellular carcinoma surgery: a multi-center analysis. Surg Today. 2018;48:73–9.
doi: 10.1007/s00595-017-1553-3
Schack A, Berkfors AA, Ekeloef S, et al. The effect of perioperative iron therapy in acute major noncardiac surgery on allogenic blood transfusion and postoperative haemoglobin levels: a systematic review and meta-analysis. World J Surg. 2019;43:1677–91.
doi: 10.1007/s00268-019-04971-7
Portuondo JI, Shah SR, Signh H, et al. Failure to rescue as a surgical quality indicator: current concepts and future directions for improving surgical outcomes. Anesthesiology. 2019;131:426–37.
doi: 10.1097/ALN.0000000000002602