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Zhao S, Sun L, Zhou J, Li R, Sun Q, Wang W, Wang D. Advancements in Diagnosis and Multimodal Treatment Strategies for Retroperitoneal Tumors: A Comprehensive Review. Am J Clin Oncol 2024; 47:350-356. [PMID: 38476111 DOI: 10.1097/coc.0000000000001094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
Retroperitoneal tumors (RPTs) encompass both benign and malignant entities, constituting ~0.1% to 0.2% of all malignant tumors, of which 70% to 80% manifest malignancy. Predominantly, retroperitoneal sarcomas (RPS) represent the most prevalent subtype among RPT. With over 70 histologic forms identified, liposarcomas and leiomyosarcomas emerge as the primary constituents of RPS. Accurate diagnosis of RPTs necessitates preoperative core-needle biopsy and comprehensive imaging assessment. The current staging protocol for RPS relies on the eighth edition of the American Joint Committee on Cancer/TNM classification. Surgical excision remains the established gold standard for treating RPS. Therapeutic approaches vary according to the underlying pathophysiology. Although chemotherapy and radiotherapy exhibit efficacy in managing metastatic and recurrent unresectable RPS, their role in primary RPS remains unresolved, necessitating further clinical trials for validation. Concurrently, ongoing research explores the potential of targeted therapies and immunotherapy. This literature review aims to provide a comprehensive overview of existing research, delineating diagnostic pathways and optimal therapeutic strategies for RPT.
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Affiliation(s)
- Shuai Zhao
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University
| | - Longhe Sun
- Department of General Surgery, Northern Jiangsu People's Hospital, Yangzhou
| | - Jiajie Zhou
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University
| | - Ruiqi Li
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University
| | - Qiannan Sun
- Department of General Surgery, Taizhou Fourth People's Hospital
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
| | - Wei Wang
- Department of General Surgery, Taizhou Fourth People's Hospital
| | - Daorong Wang
- Department of General Surgery, Northern Jiangsu People's Hospital, Clinical Teaching Hospital of Medical School, Nanjing University
- Department of General Surgery, Taizhou Fourth People's Hospital
- Yangzhou Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic Diseases, Yangzhou, China
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Sarre-Lazcano C, Dumitra S, Fiore M. Pelvic soft tissue sarcomas. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:1102-1110. [PMID: 35725682 DOI: 10.1016/j.ejso.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 05/28/2022] [Accepted: 06/01/2022] [Indexed: 12/20/2022]
Abstract
Pelvic soft tissue sarcomas (PSTS) are a rare, heterogeneous group of tumors. They have been usually analyzed with retroperitoneal sarcomas (RPS), but actually have key differences. Due to their unique anatomic location, symptomatic presentation of PSTS may be more common than RPS. Adequate imaging approach is paramount for guiding differential diagnosis, while preoperative biopsy is mandatory, especially when preoperative treatment may be considered as initial approach. The most frequent histologic subtype is leiomyosarcoma, which is different as expected in the retroperitoneum where liposarcoma is the commonest histology. Also solitary fibrous tumor is commonly diagnosed in the pelvis. Surgical approach for PSTS differs from that for RPS mainly due to anatomic relations. Similarly, in the lack of definite evidence from specific trials about neoadjuvant and adjuvant treatments, the anatomic constraints to obtain wide margins in the pelvis as well as the expected functional outcome in case of organ resections should be factored into decision for individualized treatment offer. Vascular and genitourinary involvement are frequent, as well as herniation through pelvic foramina. For these reasons a multidisciplinary surgical team should always be considered. Early referral of these patients to high-volume centers is critical and may impact on survival, given that optimal initial resection is a major predictor of curative treatment. International consensus on PSTS treatment is advocated, similarly to the recent efforts realized for RPS.
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Affiliation(s)
- Catherine Sarre-Lazcano
- Department of Surgery, Salvador Zubiran National Institute of Medical Sciences and Nutrition: Salvador Zubiran, Mexico City, Mexico
| | - Sinziana Dumitra
- Department of Surgery, McGill University Health Centre, Montreal, Canada
| | - Marco Fiore
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
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Feng Q, Li Z, Zhang X, Feng J, Wang D. Study of the efficacy of 3D-printed prosthetic reconstruction after pelvic tumour resection. J Biomater Appl 2023; 37:1626-1631. [PMID: 36847197 DOI: 10.1177/08853282231161110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The purpose of this study is to explore the effect of using 3D printed pelvic prosthesis to reconstruct bone defect after pelvic tumor resection. From June 2018 to October 2021, a total of 10 patients with pelvic tumors underwent pelvic tumor resection and 3D printed customized hemipelvic prosthesis reconstruction in our hospital. Enneking pelvic surgery subdivision method was used to determine the degree of tumor invasion and the site of prosthesis reconstruction. 2 cases in Zone I, 2 cases in Zone II, 3 cases in Zone I + II, 2 cases in Zone II + III and 1 case in Zone I + II + III. Patients had preoperative VAS scores of 6.5 ± 1.3, postoperative VAS scores of 2.2 ± 0.9, preoperative MSTS-93 scores of 9.4 ± 5.3 and postoperative 19.4 ± 5.9(p < 0.05), all patients had improvement in pain after surgery; Postoperative complications included joint dislocation in 2 cases, myasthenia caused by Guillain-Barre syndrome in 1 case, delayed wound healing in 3 cases and wound infection in 2 cases. Postoperative wound-related complications and dislocations were associated with the extent of the tumor. Patients with tumor invasion of the iliopsoas and gluteus medius muscles had higher complication rates and worse postoperative MSTS scores (p < 0.05). The patients were followed up for 8 ∼ 28 months. During the follow-up period, 1 case recurred, 4 cases metastasized and 1 case died. All pelvic CTs reviewed 3-6 months after surgery showed good alignment between the 3D printed prosthesis and the bone contact, and tomography showed the growth of trabecular structures into the bone. Overall pain scores decreased and functional scores improved in patients after 3D printed prosthesis replacement for pelvic tumor resection. Long-term bone ingrowth could be seen on the prosthesis-bone contact surface with good stability.
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Affiliation(s)
- Qi Feng
- Department of Orthopedics, 117878The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zenghuai Li
- Department of Orthopedics, 117878The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiaoyu Zhang
- Department of Orthopedics, 117878The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jiangang Feng
- Department of Orthopedics, 117878The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Donglai Wang
- Department of Orthopedics, 117878The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Khan M, Wilkerson H, Vassos N, Hannay JA, Thway K, Messiou C, Hayes AJ, Strauss DC, Smith MJ. Oncologic outcomes of surgically managed primary pelvic soft tissue sarcoma; tumour biology or surgical constraints of the true pelvis? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 49:941-949. [PMID: 36566120 DOI: 10.1016/j.ejso.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Pelvic soft tissue sarcomas are rare. Potentially curative resection remains challenging due to anatomical constraints of true pelvis and tumour spread through various anatomical hiatus. We sought to review the oncological outcomes of surgically managed cases at our centre and determine whether outcomes differ for patients with localised (limited to pelvis) versus extensive disease (with extra-pelvic extension). METHODS Sixty-seven patients who underwent surgical resection with curative intent at the centre for primary, non-metastatic, WHO intermediate to high-grade soft tissue sarcoma of the true pelvis from January 2012 through January 2020 were analysed. Establishment of the extent of disease was made by review of pre-treatment imaging and surgical notes. Oncologic endpoints examined were resection margin, recurrence rate, disease-free and overall survival. RESULTS Rates of complete oncological resection and disease control were similar for tumours with localised or extensive disease. On logistic regression analysis, tumour grade, and a negative resection margin (R0) correlated with the risk of recurrence (p=<0.05). On further multinomial analysis, R0 resection was associated with improved local control, but not metastatic relapse (p = 0.003). 5-year local recurrence-free and distant metastasis-free survival were 61.3% and 67.1%, respectively. Five and 10-year overall survival were 64% and 36%, respectively. Age >50 years and high tumour grade were associated with a worse outcome (p < 0.05). CONCLUSIONS When potentially curative surgery is performed for pelvic sarcoma, disease-extent does not influence oncologic outcomes. While a complete oncologic resection determines the risk of local recurrence, tumour grade and metastatic relapse remain primary prognostic determinants for overall survival.
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Affiliation(s)
- Misbah Khan
- The Royal Marsden Hospital NHS Foundation Trust, United Kingdom
| | | | - Nikolaos Vassos
- The Royal Marsden Hospital NHS Foundation Trust, United Kingdom
| | | | - Khin Thway
- The Royal Marsden Hospital NHS Foundation Trust, United Kingdom; The Institute of Cancer Research, United Kingdom
| | - Christina Messiou
- The Royal Marsden Hospital NHS Foundation Trust, United Kingdom; The Institute of Cancer Research, United Kingdom
| | - Andrew J Hayes
- The Royal Marsden Hospital NHS Foundation Trust, United Kingdom; The Institute of Cancer Research, United Kingdom
| | - Dirk Cornelius Strauss
- The Royal Marsden Hospital NHS Foundation Trust, United Kingdom; The Institute of Cancer Research, United Kingdom
| | - Myles Jf Smith
- The Royal Marsden Hospital NHS Foundation Trust, United Kingdom; The Institute of Cancer Research, United Kingdom.
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Patkar S, Kattepur AK, Khanna N, Bajpai J. Retroperitoneal Sarcomas: a Current Review on Management. Indian J Surg Oncol 2022; 13:542-558. [PMID: 36187536 PMCID: PMC9515254 DOI: 10.1007/s13193-022-01520-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/08/2022] [Indexed: 11/25/2022] Open
Abstract
Retroperitoneal sarcomas are heterogeneous tumours with variable disease biology and outcomes. The prognosis is primarily related to tumour histology and grade as well as the ability to achieve margin negative resection. Surgery involves compartment or contiguous organ resection to achieve the above goal. Careful utilization of neoadjuvant and adjuvant strategies like radiotherapy and/or chemotherapy can lead to improvement in margin status, thereby contributing to better local control and possibly reducing systemic dissemination. Use of targeted therapies has paved newer pathways of treatment integration centred on molecular and genetic targets. The aim of this review is to update the reader on all aspects of retroperitoneal sarcoma management including emphasis on pertinent and landmark trials in this regard.
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Affiliation(s)
- Shraddha Patkar
- Department of Gastrointestinal Oncology, Hepatobiliary Services, Tata Memorial Centre and HBNI, Dr Ernst Borges Marg, Parel, Mumbai 400012 India
| | - Abhay K. Kattepur
- Department of Surgical Oncology, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnataka India
| | - Nehal Khanna
- Department of Radiation Oncology, Tata Memorial Centre and HBNI, Dr Ernst Borges Marg, Parel, Mumbai India
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Centre and HBNI, Dr Ernst Borges Marg, Parel, Mumbai India
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Vidri RJ, Howell KJ, Meyer JE, Rivard MJ, Emrich JG, Price RA, Farma JM, Turian JV, Poli J, Wang D. Initial Clinical Experience With Novel Directional Low-dose Rate Brachytherapy for Retroperitoneal Sarcoma. J Surg Res 2021; 268:411-418. [PMID: 34416413 DOI: 10.1016/j.jss.2021.06.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/27/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND A novel Palladium-103 low-dose rate (LDR) brachytherapy device was developed to provide dose-escalation to the tumor bed after resection while shielding adjacent tissues. This multicenter report describes the initial experience with this device in patients with retroperitoneal sarcoma (RPS). MATERIALS AND METHODS Patients with recurrent RPS, prior radiotherapy, and/or concern for positive margins were considered. An LDR brachytherapy dose of 20-60 Gy was administered, corresponding to biologically effective dose values of 15-53 Gy and equivalent dose values of 12-43 Gy. RESULTS Six patients underwent implantation at four institutions. Of these, five had recurrent disease in the retroperitoneum or pelvic sidewall, one had untreated locally advanced leiomyosarcoma, two had prior external beam radiation therapy at the time of initial diagnosis, and four received neoadjuvant external beam radiation therapy plus brachytherapy. The device was easily implanted and conformed to the treatment area. Median follow-up was 16 mo; radiation was delivered to the at-risk margin with minimal irradiation of adjacent structures. No local recurrences at the site of implantation, device migration, or radiation-related toxicities were observed. CONCLUSIONS The novel LDR directional brachytherapy device successfully delivered a targeted dose escalation to treat RPS high-risk margins. Lack of radiation-related toxicity demonstrates its safety.
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Affiliation(s)
- Roberto J Vidri
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
| | - Krisha J Howell
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Joshua E Meyer
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Mark J Rivard
- Department of Radiation Oncology, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jacqueline G Emrich
- Department of Radiation Oncology, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Robert A Price
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jeffrey M Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Julius V Turian
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Jaganmohan Poli
- Department of Radiation Oncology, Geisinger Medical Center, Danville, Pennsylvania
| | - Dian Wang
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
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Xu L, Qin H, Tan J, Cheng Z, Luo X, Tan H, Huang W. Clinical study of 3D printed personalized prosthesis in the treatment of bone defect after pelvic tumor resection. J Orthop Translat 2021; 29:163-169. [PMID: 34277347 PMCID: PMC8258599 DOI: 10.1016/j.jot.2021.05.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 05/01/2021] [Accepted: 05/26/2021] [Indexed: 12/11/2022] Open
Abstract
Background /Objective: In recent years, prostheses have been widely used for limb reconstruction after pelvic tumour resection. However, prostheses are associated with problems leading to tumour recurrence, poor implant matching, defects after tumour resection, and easy implant looseness or failure. To achieve a precise preoperative design, complete tumour resection, and better anatomical structure matching and prosthesis stability, this study used three-dimensionally (3D)-printed osteotomy guides and personalised prostheses for reconstruction after pelvic tumour resection. This study aimed to explore the early clinical efficacy of 3D printed personalised prostheses for the reconstruction of bone defects after pelvic tumour resection. Methods A total of 20 patients (12 males, 8 females) with pelvic tumours surgically treated at our hospital between October 2014 and October 2019 were selected. There were 10 cases each of giant cell bone tumours and osteochondrosarcomas. According to Enneking zoning, there were 11 and 9 cases with tumours located in zones I and II, respectively. All cases were equally divided into conventional and 3D printing groups. For repair and reconstruction, a nail rod system or a steel plate was used in the conventional group while individualised 3D-printed prostheses were used in the 3D printing group. The surgical incision, duration of surgery, intraoperative blood loss, and the negative rate of resection margins in postoperative tumour specimens were examined. The follow-up focused on tumour recurrence, complications, and the Musculoskeletal Tumor Society (MSTS) score. Results All cases were followed-up for 6-24 months. The average incision length, duration of surgery, amount of intraoperative blood loss, and MSTS score of the 3D printing group were 10.0 ± 3.1 cm, 115.2 ± 25.3 min, 213.2 ± 104.6 mL, 23.8 ± 1.3, respectively, and those of the conventional group were 19.8 ± 8.4 cm, 156.8 ± 61.4 min, 361.4 ± 164.2 mL, and 18.3 ± 1.4, respectively. Histological tumour specimen examination showed nine and three cases with negative resection margins in the 3D printing group and the conventional group, respectively. The abovementioned indicators were significantly different between both groups (P < 0.05). Conclusion Applying 3D printed surgical guides and personalised prostheses for pelvic tumour resection, repair, and reconstruction, as well as preoperative planning and design, enables more accurate tumour resections and better prosthesis-patient matchings, possibly reducing surgical trauma, shortening the duration of surgery, and promoting the functional recovery of patients postoperatively. The Translation Potential of this Article Contrary to existing studies on 3D printed personalised prostheses, this study reports the clinical efficacy of the aforementioned technology in treating bone defects in a series of patients who underwent pelvic tumour resection. Moreover, it presents a comprehensive comparison of this technology with conventional procedures, thus strengthening its importance in treatment regimens for reconstructing bone defects.
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Affiliation(s)
- Lin Xu
- Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning 530021, China.,Department of Orthopedics, Guigang City People's Hospital, Guangxi Digital Medicine and 3D Printing Clinical Research Center, Guangxi Zhuang Autonomous Region, Guigang 537100, China
| | - Hao Qin
- Department of Orthopedics, Guigang City People's Hospital, Guangxi Digital Medicine and 3D Printing Clinical Research Center, Guangxi Zhuang Autonomous Region, Guigang 537100, China.,Department of Orthopedics, The People's Hospital of Gaozhou, Maoming 525200, Guangdong Province, China
| | - Jia Tan
- 3D Printing Clinical and Translational Research Center, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - Zhilin Cheng
- Department of Orthopedics, Guigang City People's Hospital, Guangxi Digital Medicine and 3D Printing Clinical Research Center, Guangxi Zhuang Autonomous Region, Guigang 537100, China
| | - Xiang Luo
- Department of Orthopedics, Guigang City People's Hospital, Guangxi Digital Medicine and 3D Printing Clinical Research Center, Guangxi Zhuang Autonomous Region, Guigang 537100, China
| | - Haitao Tan
- Department of Orthopedics, Guigang City People's Hospital, Guangxi Digital Medicine and 3D Printing Clinical Research Center, Guangxi Zhuang Autonomous Region, Guigang 537100, China
| | - Wenhua Huang
- Guangxi Medical University, Guangxi Zhuang Autonomous Region, Nanning 530021, China.,Guangdong Engineering Research Center for Translation of Medical 3D Printing Application, Guangdong Provincial Key Laboratory of Medical Biomechanics, National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou 510515, China.,Guangdong Medical Innovation Platform for Translation of 3D Printing Application, The Third Affiliated Hospital of Southern Medical University, Southern Medical University, Guangzhou 510000, China
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Sandrucci S, Ponzetti A, Gianotti C, Mussa B, Lista P, Grignani G, Mistrangelo M, Bertetto O, Di Cuonzo D, Ciccone G. Different quality of treatment in retroperitoneal sarcomas (RPS) according to hospital-case volume and surgeon-case volume: a retrospective regional analysis in Italy. Clin Sarcoma Res 2018; 8:3. [PMID: 29507712 PMCID: PMC5830336 DOI: 10.1186/s13569-018-0091-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 02/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background Retroperitoneal sarcomas (RPS) should be surgically managed in specialized sarcoma centers. However, it is not clearly demonstrated if clinical outcome is more influenced by Center Case Volume (CCV) or by Surgeon Case Volume (SCV). The aim of this study is to retrospectively explore the relationship between CCV and SCV and the quality of surgery in a wide region of Northern Italy. Methods We retrospectively collected data about patients M0 surgically treated for RPSs in 22 different hospitals from 2006 to 2011, dividing them in two hospital groups according to sarcoma clinical activity volume (HCV, high case volume or LCV, low case volume hospitals). The HCV group (> 100 sarcomas observed per year) included a Comprehensive Cancer Center (HVCCC) with a high sarcoma SCV (> 20 cases/year), and a Tertiary Academic Hospital (HVTCA) with multiple surgeon teams and a low sarcoma SCV (≤ 5 cases/year for each involved surgeon). All other hospitals were included in the LCV group (< 100 sarcomas observed per year). Results Data regarding 138 patients were collected. Patients coming from LCV hospitals (66) were excluded from the analysis as prognostic data were frequently not available. Among the 72 remaining cases of HCV hospitals 60% of cases had R0/R1 margins, with a more favorable distribution of R0/R1 versus R2 in HVCCC compared to HVTCA. Conclusions In HCV hospitals, sarcoma SCV may significantly influence RPS treatment quality. In low-volume centers surgical reports can often miss important prognostic issues and surgical quality is generally poor.
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Affiliation(s)
- Sergio Sandrucci
- 1Visceral Sarcoma Unit, University of Turin, Cso Dogliotti 14, 10126 Turin, Italy
| | - Agostino Ponzetti
- Medical Oncology 1 Division, Città della Salute e della Scienza, Turin, Italy
| | - Claudio Gianotti
- 1Visceral Sarcoma Unit, University of Turin, Cso Dogliotti 14, 10126 Turin, Italy
| | - Baudolino Mussa
- 3Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Patrizia Lista
- Medical Oncology 1 Division, Città della Salute e della Scienza, Turin, Italy
| | - Giovanni Grignani
- 4Department of Medical Oncology, Candiolo Cancer Institute-FPO, IRCCS, Candiolo, Italy
| | | | | | - Daniela Di Cuonzo
- Cancer Epidemiology Unit, Città della Salute e della Scienza, Turin, Italy
| | - Giovannino Ciccone
- Cancer Epidemiology Unit, Città della Salute e della Scienza, Turin, Italy
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Kim DB, Gray R, Li Z, Wasif N, Bagaria SP. Effect of nephrectomy for retroperitoneal sarcoma on post-operative renal function. J Surg Oncol 2017; 117:425-429. [PMID: 29044533 DOI: 10.1002/jso.24875] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/17/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Surgical resection of retroperitoneal sarcomas (RPS) often involves removal of the ipsilateral kidney. We evaluated the long-term post-operative renal function in patients who underwent a nephrectomy as part of their en-bloc resection of RPS. METHODS Retrospective review of an institutional database identified RPS patients who underwent nephrectomy for curative intent from 1990 to 2014. The primary outcome measured was chronic kidney disease (CKD) calculated by the glomerular filtration rate (GFR). RESULTS Of the 47 patients in our study, 19 (40%), 18 (38%), and 10 (21%) patients had a preoperative CKD stage 1, 2, and 3, respectively. The GFR decreased by an average of 33.4 mL/min/1.73 m2 with 66% of patients demonstrating mild progression of their renal impairment. Only three (6%) patients progressed to CKD stage 4 or 5, one of which required life-long dialysis. CONCLUSION Nephrectomy as part of an en-bloc resection is associated with a decrease in GFR that is not clinically significant. Fear of kidney failure should not prevent a surgeon from performing a nephrectomy in the treatment of RPS.
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Affiliation(s)
- Daniel B Kim
- Department of Surgery, Mayo Clinic, Jacksonville, Florida
| | - Richard Gray
- Department of Surgery, Mayo Clinic, Scottsdale, Arizona
| | - Zhuo Li
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - Nabil Wasif
- Department of Surgery, Mayo Clinic, Scottsdale, Arizona
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10
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Fujimoto N, Kubo T, Hisaoka M, Udo K, Yokomizo A, Shibuya T, Wakeda H, Nishihara K, Moriya R, Iwakuma K. Demographics, management and treatment outcomes of benign and malignant retroperitoneal tumors in Japan. Int J Urol 2017; 25:61-67. [PMID: 28994196 DOI: 10.1111/iju.13469] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 08/27/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To show the demographics, type of treatment and clinical outcomes of patients with retroperitoneal tumors in Japan. METHODS We carried out a retrospective analysis of patients with retroperitoneal tumors treated between 2000 and 2012 at 12 university hospitals in Japan. Histology was re-evaluated using the 2013 World Health Organization classification. RESULTS A total of 167 patients were included in the analysis. The number of diagnosed patients increased over the 12-year study period. Liposarcoma and schwannoma were the most common histological types among intermediate/malignant and benign tumors, respectively. The intermediate/malignant tumors were larger and were more frequently found in older people. Surgical resection was the primary treatment for 151 patients. The median survival duration for patients with malignant tumors was 91 months, and was significantly shorter than that for patients with benign and intermediate tumors (P < 0.01). R2 resection was associated with significantly shorter survival than R0/R1 resection for malignant tumors (P < 0.01), but not for intermediate. Grossly complete resection of the recurrent tumors improved survival. CONCLUSION The number of patients diagnosed with retroperitoneal tumors increased over time. R2 resection of primary tumors was found to be associated with poor prognosis in malignant tumors, but not in intermediate tumors. Complete surgical resection of recurrent tumors was associated with a better oncological outcome.
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Affiliation(s)
- Naohiro Fujimoto
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Tatsuhiko Kubo
- Department of Public Health, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masanori Hisaoka
- Department of Pathology and Oncology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kazuma Udo
- Department of Urology, Saga University, Saga, Japan
| | - Akira Yokomizo
- Department of Urology, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | | | - Hironobu Wakeda
- Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | | | - Ryosuke Moriya
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Keiko Iwakuma
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu, Japan
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11
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Goodman LF, Bateni CP, Bishop JW, Canter RJ. Delayed phlegmon with gallstone fragments masquerading as soft tissue sarcoma. J Surg Case Rep 2016; 2016:rjw106. [PMID: 27333918 PMCID: PMC4917179 DOI: 10.1093/jscr/rjw106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Complications from lost gallstones after cholecystectomy are rare but varied from simple perihepatic abscess to empyema and expectoration of gallstones. Gallstone complications have been reported in nearly every organ system, although reports of malignant masquerade of retained gallstones are few. We present the case of an 87-year-old woman with a flank soft tissue tumor 4 years after laparoscopic cholecystectomy. The initial clinical, radiographic and biopsy findings were consistent with soft tissue sarcoma (STS), but careful review of her case in multidisciplinary conference raised the suspicion for retained gallstones rather than STS. The patient was treated with incisional biopsy/drainage of the mass, and gallstones were retrieved. The patient recovered completely without an extensive resectional procedure, emphasizing the importance of multidisciplinary sarcoma care to optimize outcomes for potential sarcoma patients.
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Affiliation(s)
- Laura F Goodman
- Division of Surgical Oncology, UC Davis School of Medicine, Sacramento, CA, USA
| | - Cyrus P Bateni
- Department of Radiology, UC Davis School of Medicine, Sacramento, CA, USA
| | - John W Bishop
- Department of Pathology and Laboratory Medicine, UC Davis School of Medicine, Sacramento, CA, USA
| | - Robert J Canter
- Division of Surgical Oncology, UC Davis School of Medicine, Sacramento, CA, USA
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Stephen AH, Fallon EA, Kalife E, Wanebo H. Radiation-associated sarcoma after recurrent colorectal primary tumor: A complex surgical case. J Surg Oncol 2015; 112:658-61. [PMID: 26430853 DOI: 10.1002/jso.24059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 09/23/2015] [Indexed: 11/12/2022]
Abstract
Radiation associated sarcoma is a significant consequence of cancer therapy. Incidence of radiation associated sarcoma correlates with overall radiotherapy exposure. Prognosis is generally poor with 5 year survival rates lower than that for spontaneously occurring sarcomas. Surgical management presents many challenges including having to work in irradiated tissue planes while trying to achieve negative margins. We present a patient with a rare radiation associated pelvic sarcoma whose course illustrates the complexity of this problem.
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Affiliation(s)
- Andrew H Stephen
- Department of Surgery, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Eleanor A Fallon
- Department of Surgery, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Elizabeth Kalife
- Department of Pathology, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Harold Wanebo
- Department of Surgery, Miriam Hospital, Providence, Rhode Island
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