Morbidity and Outcomes After Distal Pancreatectomy for Primary Retroperitoneal Sarcoma: An Analysis by the Trans-Atlantic Australasian Retroperitoneal Sarcoma Working Group.
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:
Oct 2021
Oct 2021
Historique:
received:
27
08
2020
accepted:
23
01
2021
pubmed:
20
3
2021
medline:
28
9
2021
entrez:
19
3
2021
Statut:
ppublish
Résumé
Multi-visceral resection often is used in the treatment of retroperitoneal sarcoma (RPS). The morbidity after distal pancreatectomy for primary pancreatic cancer is well-documented, but the outcomes after distal pancreatectomy for primary RPS are not. This study aimed to evaluate morbidity and oncologic outcomes after distal pancreatectomy for primary RPS. In this study, 26 sarcoma centers that are members of the Trans-Atlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG) retrospectively identified consecutive patients who underwent distal pancreatectomy for primary RPS from 2008 to 2017. The outcomes measured were 90-day severe complications (Clavien-Dindo ≥ 3), postoperative pancreatic fistula (POPF) rate, and oncologic outcomes. Between 2008 and 2017, 280 patients underwent distal pancreatectomy for primary RPS. The median tumor size was 25 cm, and the median number of organs resected, including the pancreas, was three. In 96% of the operations, R0/R1 resection was achieved. The 90-day severe complication rate was 40 %. The grades B and C POPF complication rates were respectively 19% and 5% and not associated with worse overall survival. Administration of preoperative radiation and factors to mitigate POPF did not have an impact on the risk for the development of a POPF. The RPS invaded the pancreas in 38% of the patients, and local recurrence was doubled for the patients who had a microscopic, positive pancreas margin (hazard ratio, 2.0; p = 0.042). Distal pancreatectomy for primary RPS has acceptable morbidity and oncologic outcomes and is a reasonable approach to facilitate complete tumor resection.
Sections du résumé
BACKGROUND
BACKGROUND
Multi-visceral resection often is used in the treatment of retroperitoneal sarcoma (RPS). The morbidity after distal pancreatectomy for primary pancreatic cancer is well-documented, but the outcomes after distal pancreatectomy for primary RPS are not. This study aimed to evaluate morbidity and oncologic outcomes after distal pancreatectomy for primary RPS.
METHODS
METHODS
In this study, 26 sarcoma centers that are members of the Trans-Atlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG) retrospectively identified consecutive patients who underwent distal pancreatectomy for primary RPS from 2008 to 2017. The outcomes measured were 90-day severe complications (Clavien-Dindo ≥ 3), postoperative pancreatic fistula (POPF) rate, and oncologic outcomes.
RESULTS
RESULTS
Between 2008 and 2017, 280 patients underwent distal pancreatectomy for primary RPS. The median tumor size was 25 cm, and the median number of organs resected, including the pancreas, was three. In 96% of the operations, R0/R1 resection was achieved. The 90-day severe complication rate was 40 %. The grades B and C POPF complication rates were respectively 19% and 5% and not associated with worse overall survival. Administration of preoperative radiation and factors to mitigate POPF did not have an impact on the risk for the development of a POPF. The RPS invaded the pancreas in 38% of the patients, and local recurrence was doubled for the patients who had a microscopic, positive pancreas margin (hazard ratio, 2.0; p = 0.042).
CONCLUSION
CONCLUSIONS
Distal pancreatectomy for primary RPS has acceptable morbidity and oncologic outcomes and is a reasonable approach to facilitate complete tumor resection.
Identifiants
pubmed: 33740198
doi: 10.1245/s10434-021-09739-9
pii: 10.1245/s10434-021-09739-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
6882-6889Commentaires et corrections
Type : CommentIn
Type : ErratumIn
Informations de copyright
© 2021. Society of Surgical Oncology.
Références
Kleeff J, et al. Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases. Ann Surg. 2007;245:573–82.
doi: 10.1097/01.sla.0000251438.43135.fb
Lillemoe KD, et al. Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg. 1999;229:693–8; discussion 698–700.
Reeh M, et al. High surgical morbidity following distal pancreatectomy: still an unsolved problem. World J Surg. 2011;35:1110–7.
doi: 10.1007/s00268-011-1022-x
Ecker BL, et al. Risk factors and mitigation strategies for pancreatic fistula after distal pancreatectomy: analysis of 2026 resections from the International, Multi-institutional Distal Pancreatectomy Study Group. Ann Surg. 2019;269:143–9.
doi: 10.1097/SLA.0000000000002491
Gronchi A, 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
Tseng WW, Pollock RE, Gronchi A. The Trans-Atlantic Retroperitoneal Sarcoma Working Group (TARPSWG): “red wine or white”? Ann Surg Oncol. 2016;23:4418–20.
doi: 10.1245/s10434-016-5538-z
MacNeill AJ, et al. Postoperative morbidity after radical resection of primary retroperitoneal sarcoma: a report from the Transatlantic RPS Working Group. Ann Surg. 2018;267:959–64.
doi: 10.1097/SLA.0000000000002250
Trans-Atlantic Retroperitoneal Sarcoma Working Group. Management of metastatic retroperitoneal sarcoma: a consensus approach from the Trans-Atlantic Retroperitoneal Sarcoma Working Group (TARPSWG). Ann Oncol. 2018;29:857–71.
doi: 10.1093/annonc/mdy052
van Houdt WJ, et al. New research strategies in retroperitoneal sarcoma: the case of TARPSWG, STRASS, and RESAR: making progress through collaboration. Curr Opin Oncol. 2019;31:310–6.
doi: 10.1097/CCO.0000000000000535
Raut CP, 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
Haas RLM, et al. Radiotherapy for retroperitoneal liposarcoma: a report from the Transatlantic Retroperitoneal Sarcoma Working Group. Cancer. 2019;125:1290–300.
doi: 10.1002/cncr.31927
Bassi C, et al. (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. 2017;161:584–91.
doi: 10.1016/j.surg.2016.11.014
Keung EZ, et al. Postoperative pancreatic fistula after distal pancreatectomy for non-pancreas retroperitoneal tumor resection. Am J Surg. 2020;220:140–6.
doi: 10.1016/j.amjsurg.2019.11.026
Miao Y, et al. Management of the pancreatic transection plane after left (distal) pancreatectomy: expert consensus guidelines by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2020.
Fairweather M, et al. Incidence and adverse prognostic implications of histopathologic organ invasion in primary retroperitoneal sarcoma. J Am Coll Surg. 2017;224:876–83.
doi: 10.1016/j.jamcollsurg.2017.01.044
Toulmonde M, et al. Retroperitoneal sarcomas: patterns of care at diagnosis, prognostic factors, and focus on main histological subtypes: a multicenter analysis of the French Sarcoma Group. Ann Oncol. 2014;25:735–42.
doi: 10.1093/annonc/mdt577
Berselli M, et al. Morbidity of left pancreatectomy when associated with multivisceral resection for abdominal mesenchymal neoplasms. JOP. 2011;12:138–44.
pubmed: 21386639
pmcid: 21386639