gms | German Medical Science

Introduction: Retroperitoneal soft tissue sarcomas (RSTS) are rare tumor entities. The only chance of curative treatment is the radical surgical resection which then leads to a substantial survival benefit. Due to small patient numbers the establishment of evidence based therapy concepts remains difficult. In this study prognostic factors and the effect of surgical therapy was analysed.

Material and methods: Data from 47 patients who underwent surgery for retroperitoneal soft tissue sarcoma from 2001 to 2013 in a single institution (Department of General- and Visceral Surgery, University of Freiburg) were reviewed retrospectively. 5 patients were excluded due to missing data. SPSS was used for univariate analysis of prognostic factors and overall survival in 43 patients with primary retroperitoneal soft tissue sarcoma.

Results: The median age was 59.6 years (range: 33-83 years). 42.2% of the patients were younger than 55 years while 57.8% of the patients exceeded 55 years of age. The 5-year overall survival in patients younger than 55 years was 88.9% ± 7.4% while the overall survival in patients older than 55 was 60.8% ± 11.3% (p=0.082). Histology in 72.1% of the patients showed liposarcoma, while 16.3% and 7% of the patients showed leiomyosarcoma and malignant fibrous histiocytoma respectively. FNCLCC grading 1 and 2 was observed in 37.2% and classified as low grade sarcoma, while FNLCC grade 3 tumors were observed in 62.8% and classified as high grade sarcoma. The latter showed a trend in decreased 5-year overall survival with 57% ± 13.8% compared to low grade tumors with 84.3%±7,2% (p=0.131). R0 resection was achieved in 50% of the patients, R1 resection in 19.1% and R2 resection in 30.9%, which did not lead to significant changes in 5-year overall survival (R0: 74.9% ±12.1%; R1: 62.5%±17.1%; R2: 70%±14.5%; p=0,566). The 5-year overall survival was also not influenced by local resection compared to resections including involved adjacent organs (78.8% ± 11% local resection vs. 71.5%±9.3% extended resections; p=0.569). Patients receiving resection of sarcoma recurrence showed an identical 5-year overall survival when compared to patients without resection and recurrence (78.0%±8.7, 69.8%±11.6; p=0.365). In patients where repeated recurrences occurred, tumor biology was characterized by slow tumor growth which led to a 5-year overall survival of all patients. Adjuvant and additive radiotherapy in combination with intraoperative radiotherapy showed a trend to improved survival for patients receiving radiotherapy (radiotherapy 80.8 %±10.2%, no radiotherapy 67.1%±10.4% p=0.226).

Conclusion: If in patients resection of local recurrence of retroperitoneal soft tissue sarcoma is performed, these patients show a similar 5-year overall survival compared to patients without local recurrence. This effect may be due to slow tumor growth. Additionally, additive or adjuvant radiotherapy in our collective showed a trend for improved survival.