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Tirotta F, Ford SJ. Postoperative Complications After Retroperitoneal Sarcoma Surgery: Can We Avoid Them? Ann Surg Oncol 2023; 30:6970-6971. [PMID: 37535268 DOI: 10.1245/s10434-023-13704-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/23/2023] [Indexed: 08/04/2023]
Affiliation(s)
- Fabio Tirotta
- Midlands Abdominal and Retroperitoneal Sarcoma Unit, Department of Sarcoma and General Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Samuel J Ford
- Midlands Abdominal and Retroperitoneal Sarcoma Unit, Department of Sarcoma and General Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
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Lawless A, Zhou DDX, McDonough J, Lo H, Mar J, Lazarakis S, Ward I, Connor J, Thompson SR, Coker D, Johnston A, Gyorki DE, Hong AM. The role of radiation therapy in the management of primary retroperitoneal sarcoma: A systematic review and clinical practice guidelines from the Australia and New Zealand Sarcoma Association. Cancer Treat Rev 2023; 120:102620. [PMID: 37657126 DOI: 10.1016/j.ctrv.2023.102620] [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: 07/29/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/03/2023]
Abstract
While surgery is the mainstay of treatment for localised retroperitoneal sarcoma, the use of radiotherapy (RT) remains controversial. This systematic review aimed to evaluate the role of RT for retroperitoneal sarcoma. A systematic review using the population, intervention, comparison, and outcome model from 1990 to 2022 identified 66 studies (a mixture of preoperative and postoperative RT); one randomised controlled trial (RCT) with two publications, 18 registry studies, and 46 retrospective studies. In the RCT of preoperative RT, there was no difference in local/abdominal recurrence. The pooled analysis of this RCT and a retrospective study showed a significant abdominal recurrence free survival benefit with preoperative RT in low grade liposarcoma. The RCT and the majority of retrospective series found RT did not improve recurrence free survival (11 of 16 no difference in combined local and distant RFS, 11 of 13 no difference in distant metastasis free survival), disease specific survival (9 of 12 studies) or overall survival (33 of 49 studies). The majority of studies found no association between RT and perioperative morbidity. In summary, preoperative RT may improve local control for low grade (well-differentiated or grades 1-2 dedifferentiated) liposarcoma, but not other histological subtypes. There is no strong evidence that perioperative RT provides an overall survival benefit. Patients with low grade retroperitoneal liposarcoma can be considered for preoperative RT to improve abdominal recurrence free survival. The rationale and level of evidence in this scenario should be carefully discussed by the multidisciplinary team with patients. RT should not be routinely recommended for other histological subtypes.
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Affiliation(s)
- Anna Lawless
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Australia; Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
| | - Deborah Di-Xin Zhou
- NHMRC Clinical Trials Centre, The University of Sydney, NSW 2006, Australia; Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
| | - Joshua McDonough
- Mental Health and Suicide Prevention Research and Education Group, Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia
| | - Helen Lo
- Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
| | - Jasmine Mar
- Australia and New Zealand Sarcoma Association, Parkville, Victoria 3010, Australia
| | - Smaro Lazarakis
- Health Sciences Library, Royal Melbourne Hospital, Parkville, Victoria 3010, Australia
| | - Iain Ward
- Christchurch Hospital, Christchurch 8011, New Zealand
| | - Joanna Connor
- Te Pūriri o Te Ora, Auckland City Hospital, 2 Park Road, Grafton, Auckland 1023, New Zealand
| | - Stephen R Thompson
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW 2031, Australia; School of Clinical Medicine, UNSW Sydney, Randwick Clinical Campus, Australia
| | - David Coker
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Australia; Department of Melanoma and Surgical Oncology, and Upper Gastrointestinal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Andrew Johnston
- North Island Sarcoma Service, Auckland City Hospital, Auckland 1023, New Zealand
| | - David E Gyorki
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Angela M Hong
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Australia; Department of Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia.
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3
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Tirotta F, Fadel MG, Baia M, Parente A, Messina V, Bassett P, Almond LM, Ford SJ, Desai A, van Houdt WJ, Strauss DC. Risk Factors for the Development of Early Recurrence in Patients with Primary Retroperitoneal Sarcoma. Ann Surg Oncol 2023; 30:6875-6883. [PMID: 37423926 DOI: 10.1245/s10434-023-13754-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/31/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Disease recurrence after retroperitoneal sarcoma (RPS) surgery is common, and resection may offer no benefit for patients who experience recurrence early. This study examined the incidence of early recurrence (EREC) in RPS patients, and the association between EREC and prognosis, aiming to identify the factors associated with EREC. METHODS Patients undergoing surgery for primary RPS from 2008 to 2019 at two tertiary RPS centers were analyzed. The study defined EREC as any evidence of local recurrence and/or distant metastases on the CT scan up to 6 months after surgery. Overall survival (OS) was calculated using the Kaplan-Meier method. A multivariable analysis was performed to identify independent predictors of EREC. RESULTS Of the 692 patients who underwent surgery during the study period, 657 were included in the analysis. Sixty-five of these patients (9.9%; 95% confidence interval [CI], 7.7-12.4%) developed EREC. Five-year OS was 3% for the patients with EREC versus 76% for those without EREC (p < 0.001). Patient characteristics were compared between the EREC and non-EREC patients, and EREC was found to be significantly associated with Eastern Cooperative Oncology Group (ECOG) performance status (p = 0.006), tumor histology (p = 0.002), tumor grading (p < 0.001), radiotherapy (p = 0.04), and postoperative complications measured as a comprehensive complications index value (p = 0.003). However, the only significant independent predictor of EREC in the multivariable analysis was grade 3 tumors, with an odds ratio of 14.8 (95% CI, 4.44-49.2; p < 0.001). CONCLUSION Early recurrence is associated with a poor prognosis, and a high tumor grade is an independent predictor for the development of EREC. Patients with EREC may benefit the most from new therapeutic options such as neoadjuvant chemotherapy.
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Affiliation(s)
- Fabio Tirotta
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Michael G Fadel
- Department of Academic Surgery, Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Marco Baia
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
- Sarcoma Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Alessandro Parente
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Valentina Messina
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - L Max Almond
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Samuel J Ford
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Anant Desai
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Winan J van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan, Amsterdam, The Netherlands
| | - Dirk C Strauss
- Department of Academic Surgery, Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
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Parente A, Kamarajah SK, Thompson JP, Crook C, Aspinall S, Melvin R, Stechman MJ, Perry H, Balasubramanian SP, Pannu A, Palazzo FF, Van Den Heede K, Eatock F, Anderson H, Doran H, Wang K, Hubbard J, Aldrees A, Shore SL, Fung C, Waghorn A, Ayuk J, Bennett D, Sutcliffe RP. Risk factors for postoperative complications after adrenalectomy for phaeochromocytoma: multicentre cohort study. BJS Open 2023; 7:zrad090. [PMID: 37757753 PMCID: PMC10533033 DOI: 10.1093/bjsopen/zrad090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/13/2023] [Accepted: 07/16/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND To determine the incidence and risk factors for postoperative complications and prolonged hospital stay after adrenalectomy for phaeochromocytoma. METHODS Demographics, perioperative outcomes and complications were evaluated for consecutive patients who underwent adrenalectomy for phaeochromocytoma from 2012 to 2020 in nine high-volume UK centres. Odds ratios were calculated using multivariable models. The primary outcome was postoperative complications according to the Clavien---Dindo classification and secondary outcome was duration of hospital stay. RESULTS Data were available for 406 patients (female n = 221, 54.4 per cent). Two patients (0.5 per cent) had perioperative death, whilst 148 complications were recorded in 109 (26.8 per cent) patients. On adjusted analysis, the age-adjusted Charlson Co-morbidity Index ≥3 (OR 8.09, 95 per cent c.i. 2.31 to 29.63, P = 0.001), laparoscopic converted to open (OR 10.34, 95 per cent c.i. 3.24 to 36.23, P <0.001), and open surgery (OR 11.69, 95 per cent c.i. 4.52 to 32.55, P <0.001) were independently associated with postoperative complications. Overall, 97 of 430 (22.5 per cent) had a duration of stay ≥5 days and this was associated with an age-adjusted Charlson Co-morbidity Index ≥3 (OR 4.31, 95 per cent c.i. 1.08 to 18.26, P = 0.042), tumour size (OR 1.15, 95 per cent c.i. 1.05 to 1.28, P = 0.006), laparoscopic converted to open (OR 32.11, 95 per cent c.i. 9.2 to 137.77, P <0.001), and open surgery (OR 28.01, 95 per cent c.i. 10.52 to 83.97, P <0.001). CONCLUSION Adrenalectomy for phaeochromocytoma is associated with a very low mortality rate, whilst postoperative complications are common. Several risk factors, including co-morbidities and operative approach, are independently associated with postoperative complications and/or prolonged hospitalization, and should be considered when counselling patients.
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Affiliation(s)
- Alessandro Parente
- HPB Surgery Unit, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Sivesh K Kamarajah
- HPB Surgery Unit, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | | | | | - Ross Melvin
- Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - Helen Perry
- Department of Endocrine Surgery, University Hospital Wales, Cardiff, UK
| | | | - Arslan Pannu
- Department of General Surgery, Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
| | - Fausto F Palazzo
- Department of Endocrine Surgery, Hammersmith Hospital, London, UK
| | | | - Fiona Eatock
- Department of Endocrine Surgery, Royal Victoria Hospital, Belfast, UK
| | - Hannah Anderson
- Department of Endocrine Surgery, Royal Victoria Hospital, Belfast, UK
| | - Helen Doran
- Department of Endocrine Surgery, Salford Royal Hospital, Salford, UK
| | - Kelvin Wang
- Department of Endocrine Surgery, Salford Royal Hospital, Salford, UK
| | | | | | - Susannah L Shore
- Department of Endocrine and Breast Surgery, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
| | - Clare Fung
- Department of Endocrine and Breast Surgery, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
| | - Alison Waghorn
- Department of Endocrine and Breast Surgery, Royal Liverpool and Broadgreen University Hospitals Trust, Liverpool, UK
| | - John Ayuk
- Department of Endocrinology, Queen Elizabeth Hospital, Birmingham, UK
| | - Davinia Bennett
- Department of Anaesthetics, Queen Elizabeth Hospital, Birmingham, UK
| | - Robert P Sutcliffe
- HPB Surgery Unit, Queen Elizabeth Hospital, Birmingham, UK
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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Tirotta F, Bacon A, Collins S, Desai A, Liu H, Paley L, Strauss D, Strauss SJ. Primary retroperitoneal sarcoma: A comparison of survival outcomes in specialist and non-specialist sarcoma centres. Eur J Cancer 2023; 188:20-28. [PMID: 37178646 DOI: 10.1016/j.ejca.2023.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Consensus guidelines outline that patients with primary retroperitoneal sarcoma (RPS) should be managed within specialist sarcoma centres (SSC). There is, however, a paucity of population-based data detailing incidence and outcomes in these patients. Hence, we aimed to evaluate patterns of care among RPS patients in England and compare outcomes for those undergoing surgery in high-volume specialist sarcoma centres (HV-SSC), low-volume SSC (LV-SSC), and non-SSC (N-SSC). METHODS Data on patients diagnosed with primary RPS between 2013 and 2018 were extracted from NHS Digital's National Cancer Registration and Analysis Service using the national cancer registration dataset. Diagnostic pathways, treatment, and survival outcomes were compared between HV-SSC, LV-SSC, and N-SSC. Uni- and multivariate analyses were calculated. RESULTS Of 1878 patients diagnosed with RPS, 1120 (60%) underwent surgery within 12 months of diagnosis, with 847 (76%) operated on at SSC; of these, 432 patients (51%) were operated on in HV-SSC, and 415 (49%) in LV-SSC. One- and 5-year estimated overall survival (OS) rates for patients undergoing surgery in N-SSC were 70.6% (95% confidence interval [CI]: 64.8-75.7) and 42.0% (CI: 35.9-47.9), compared to 85.0% (CI: 81.1-88.1) and 51.7% (CI: 46.6-56.6) in LV-SSC (p < 0.01), and 87.4% (CI: 83.9-90.2) and 62.8% (CI: 57.9-67.4) in HV-SSC, (p < 0.01). After adjusting for patient- and treatment-related factors, patients treated in HV-SSC were found to have significantly longer OS than those treated at LV-SSC, with an adjusted hazard ratio of 0.78 (CI: 0.62-0.96, p < 0.05). CONCLUSION Patients with RPS undergoing surgery in HV-SSC have significantly better survival outcomes than those treated in N-SSC and L-SSC.
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Affiliation(s)
- Fabio Tirotta
- Department of Sarcoma and General Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Andrew Bacon
- National Cancer Registration and Analysis Service, NHS Digital, Wellington Place, Leeds LS1 4AP, UK
| | - Shane Collins
- National Cancer Registration and Analysis Service, NHS Digital, Wellington Place, Leeds LS1 4AP, UK; Research Department of Oncology, University College London Cancer Institute, London, UK
| | - Anant Desai
- Department of Sarcoma and General Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Hanhua Liu
- National Cancer Registration and Analysis Service, NHS Digital, Wellington Place, Leeds LS1 4AP, UK
| | - Lizz Paley
- National Cancer Registration and Analysis Service, NHS Digital, Wellington Place, Leeds LS1 4AP, UK
| | - Dirk Strauss
- Sarcoma Unit, Department of Academic Surgery, The Royal Marsden Hospital NHS Foundation Trust, London SW3 6JJ, UK
| | - Sandra J Strauss
- National Cancer Registration and Analysis Service, NHS Digital, Wellington Place, Leeds LS1 4AP, UK; Research Department of Oncology, University College London Cancer Institute, London, UK.
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Dominguez DA, Sampath S, Agulnik M, Liang Y, Nguyen B, Trisal V, Melstrom LG, Lewis AG, Paz IB, Roberts RF, Tseng WW. Surgical Management of Retroperitoneal Sarcoma. Curr Oncol 2023; 30:4618-4631. [PMID: 37232807 DOI: 10.3390/curroncol30050349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023] Open
Abstract
Surgery is the cornerstone of treatment for retroperitoneal sarcoma (RPS). Surgery should be performed by a surgical oncologist with sub-specialization in this disease and in the context of a multidisciplinary team of sarcoma specialists. For primary RPS, the goal of surgery is to achieve the complete en bloc resection of the tumor along with involved organs and structures to maximize the clearance of the disease. The extent of resection also needs to consider the risk of complications. Unfortunately, the overarching challenge in primary RPS treatment is that even with optimal surgery, tumor recurrence occurs frequently. The pattern of recurrence after surgery (e.g., local versus distant) is strongly associated with the specific histologic type of RPS. Radiation and systemic therapy may improve outcomes in RPS and there is emerging data studying the benefit of non-surgical treatments in primary disease. Topics in need of further investigation include criteria for unresectability and management of locally recurrent disease. Moving forward, global collaboration among RPS specialists will be key for continuing to advance our understanding of this disease and find more effective treatments.
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Affiliation(s)
- Dana A Dominguez
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Sagus Sampath
- Department of Radiation Oncology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Mark Agulnik
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Yu Liang
- Department of Pathology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Bao Nguyen
- Department of Diagnostic Radiology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Vijay Trisal
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Laleh G Melstrom
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Aaron G Lewis
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Isaac Benjamin Paz
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Randall F Roberts
- Division of Thoracic Surgery (Vascular Surgery Section), City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - William W Tseng
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
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Zhuang A, Chen Y, Ma L, Fang Y, Yang H, Lu W, Zhou Y, Zhang Y, Tong H. Development and validation of a nomogram for predicting morbidity in surgically resected primary retroperitoneal sarcoma. BMC Surg 2023; 23:42. [PMID: 36814201 PMCID: PMC9948406 DOI: 10.1186/s12893-023-01941-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 02/17/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Surgery is the cornerstone of the treatment for primary retroperitoneal sarcoma (RPS). The purpose of this study was to establish a nomogram predictive model for predicting postoperative morbidity in primary RPS. METHODS Clinicopathological data of patients who underwent radical resection from 2009 to 2021 were retrospectively analyzed. Risk factor analysis was performed using a logistic regression model, and modeling variables were selected based on Akaike Information Criterion. The nomogram prediction model was built on the basis of a binary logistic regression model and internally validated by calibration curves and concordance index. RESULTS A total of 319 patients were enrolled, including 162 males (50.8%). 22.9% (n = 73) were over 65 years of age, and 70.2% (n = 224) had tumors larger than 10 cm. The most common histologic subtypes were well-differentiated liposarcoma (38.2%), dedifferentiated liposarcoma (25.1%) and leiomyosarcoma (7.8%). According to the Clavien-Dindo Classification, 96 (31.1%) and 31 (11.6%) patients had grade I-II complications and grade III-V complications, respectively. Age, tumor burden, location, operative time, number of combined organ resections, weighted resected organ score, estimated blood loss and packed RBC transfusion was used to construct the nomogram, and the concordance index of which was 0.795 (95% CI 0.746-0.844). and the calibration curve indicated a high agreement between predicted and actual rates. CONCLUSIONS Nomogram, a visual predictive tool that integrates multiple clinicopathological factors, can help physicians screen RPS patients at high risk for postoperative complications and provide a basis for early intervention.
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Affiliation(s)
- Aobo Zhuang
- grid.413087.90000 0004 1755 3939Department of Neurology, Department of Medical Oncology, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China ,grid.12955.3a0000 0001 2264 7233Xiamen University Research Center of Retroperitoneal Tumor Committee of Oncology Society of Chinese Medical Association, Xiamen University, Xiamen, Fujian China
| | - Yangju Chen
- grid.413087.90000 0004 1755 3939Department of Neurology, Department of Medical Oncology, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Lijie Ma
- grid.413087.90000 0004 1755 3939Department of Neurology, Department of Medical Oncology, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Yuan Fang
- grid.413087.90000 0004 1755 3939Department of Neurology, Department of Medical Oncology, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Hua Yang
- grid.413087.90000 0004 1755 3939Department of Neurology, Department of Medical Oncology, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Weiqi Lu
- grid.413087.90000 0004 1755 3939Department of Neurology, Department of Medical Oncology, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Yuhong Zhou
- grid.413087.90000 0004 1755 3939Department of Neurology, Department of Medical Oncology, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Yong Zhang
- Department of Neurology, Department of Medical Oncology, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
| | - Hanxing Tong
- Department of Neurology, Department of Medical Oncology, Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
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8
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Ruff SM, Grignol VP, Contreras CM, Pollock RE, Beane JD. Morbidity and Mortality after Surgery for Retroperitoneal Sarcoma. Curr Oncol 2022; 30:492-505. [PMID: 36661688 PMCID: PMC9858026 DOI: 10.3390/curroncol30010039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
Retroperitoneal sarcoma (RPS) is a rare disease with over 100 histologic types and accounts for 10-15% of all soft tissue sarcomas. Due to the rarity of RPS, sarcoma centers in Europe and North America have created the Transatlantic RPS Working Group (TARPSWG) to study this disease and establish best practices for its management. Current guidelines dictate complete resection of all macro and microscopic disease as the gold standard for patients with RPS. Complete extirpation often requires a multi-visceral resection. In addition, recent evidence suggests that en bloc compartmental resections are associated with reduced rates of local recurrence. However, this approach must be balanced by the potential for added morbidity. Strategies to mitigate postoperative complications include optimization of the patient through improved preoperative nutrition and pre-habilitation therapy, referral to a high-volume sarcoma center, and implementation of enhanced recovery protocols. This review will focus on the factors associated with perioperative complications following surgery for RPS and outline approaches to mitigate poor surgical outcomes in this patient population.
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Affiliation(s)
| | | | | | | | - Joal D. Beane
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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9
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Liu W, Wang J, Ma L, Zhuang A, Xu J, He J, Yang H, Fang Y, Lu W, Zhang Y, Tong H. Which style of duodenojejunostomy is better after resection of distal duodenum. BMC Surg 2022; 22:409. [PMID: 36434558 PMCID: PMC9700921 DOI: 10.1186/s12893-022-01850-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 11/10/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Distal duodenal resections are sometimes necessary for radical surgery, but how to restore duodenal continuity is still unclear. This study aimed at determining which style of anastomosis was more suitable for the duodenojejunostomy after resection of distal duodenum. PATIENTS AND METHODS We retrospectively identified 34 patients who underwent distal duodenum resection at our center between January 2014 and December 2021. According to whether the end or the side of the proximal duodenum was involved in reconstruction, duodenojejunostomy were classified as End style (E-style) and Side style (S-style). Demographic data, clinicopathological details, and postoperative complications were analyzed between two groups. RESULTS Thirteen patients (38.2%) received E-style duodenojejunostomy, and 21 patients (62.8%) received S-style duodenojejunostomy. Comparative analysis showed that in group of E-style, patients had a lower rate of multivisceral resection(5/13 vs 18/21; P = 0.008), delayed gastric emptying (DGE) (1/13 vs 11/21; P = 0.011) and intraperitoneal infection (2/13 vs 12/21; P = 0.03). In this study, the incidence of major complications was up to 35.3% (12/34) and no patient died of complication in perioperative period. In two group, there was no difference in the incidence of major complications (E-style vs S-style: 3/13 vs 9/21; P = 0.292). CONCLUSIONS The E-style duodenojejunostomy for the reconstruction of distal duodenum resection is safe and feasible. The E-style anastomosis may have potential value in decreasing the occurrence of complications such as DGE and intraperitoneal infection, and the definitive advantages still need to be verified.
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Affiliation(s)
- Wenshuai Liu
- grid.413087.90000 0004 1755 3939Department of General Surgery, Zhongshan Hospital, Fudan University, 200032 Shanghai, People’s Republic of China
| | - Jiongyuan Wang
- grid.413087.90000 0004 1755 3939Department of General Surgery, Zhongshan Hospital, Fudan University, 200032 Shanghai, People’s Republic of China
| | - Lijie Ma
- grid.8547.e0000 0001 0125 2443Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, 200083 Shanghai, People’s Republic of China
| | - Aobo Zhuang
- grid.8547.e0000 0001 0125 2443Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, 200083 Shanghai, People’s Republic of China
| | - Jing Xu
- grid.413087.90000 0004 1755 3939Department of General Surgery, Zhongshan Hospital, Fudan University, 200032 Shanghai, People’s Republic of China
| | - Junyi He
- grid.413087.90000 0004 1755 3939Department of General Surgery, Zhongshan Hospital, Fudan University, 200032 Shanghai, People’s Republic of China
| | - Hua Yang
- grid.8547.e0000 0001 0125 2443Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, 200083 Shanghai, People’s Republic of China
| | - Yuan Fang
- grid.8547.e0000 0001 0125 2443Department of General Surgery, South Hospital of the Zhongshan Hospital/Shanghai Public Health Clinical Center, Fudan University, 200083 Shanghai, People’s Republic of China
| | - Weiqi Lu
- grid.413087.90000 0004 1755 3939Department of General Surgery, Zhongshan Hospital, Fudan University, 200032 Shanghai, People’s Republic of China
| | - Yong Zhang
- grid.413087.90000 0004 1755 3939Department of General Surgery, Zhongshan Hospital, Fudan University, 200032 Shanghai, People’s Republic of China
| | - Hanxing Tong
- grid.413087.90000 0004 1755 3939Department of General Surgery, Zhongshan Hospital, Fudan University, 200032 Shanghai, People’s Republic of China
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Tirotta F, Strauss DC. ASO Author Reflections: Retroperitoneal Sarcoma Surgery in the Elderly. Ann Surg Oncol 2022; 29:7331-7332. [PMID: 35849290 DOI: 10.1245/s10434-022-12234-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 06/30/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Fabio Tirotta
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
- Department of Academic Surgery, The Royal Marsden Hospital NHS Foundation Trust, London, UK.
| | - Dirk C Strauss
- Department of Academic Surgery, The Royal Marsden Hospital NHS Foundation Trust, London, UK
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11
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Yao Y, Wang Z, Yong L, Yao Q, Tian X, Wang T, Yang Q, Hao C, Zhou T. Longitudinal and time‐to‐event modeling for prognostic implications of radical surgery in retroperitoneal sarcoma. CPT Pharmacometrics Syst Pharmacol 2022; 11:1170-1182. [PMID: 35758865 PMCID: PMC9469699 DOI: 10.1002/psp4.12835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/12/2022] [Accepted: 06/02/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ye Yao
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery System Department of Pharmaceutics School of Pharmaceutical Sciences Peking University Beijing China
| | - Zhen Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) Department of Hepato‐Pancreato‐Biliary Surgery Sarcoma Center, Peking University Cancer Hospital and Institute Beijing China
| | - Ling Yong
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery System Department of Pharmaceutics School of Pharmaceutical Sciences Peking University Beijing China
| | - Qingyu Yao
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery System Department of Pharmaceutics School of Pharmaceutical Sciences Peking University Beijing China
| | - Xiuyun Tian
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) Department of Hepato‐Pancreato‐Biliary Surgery Sarcoma Center, Peking University Cancer Hospital and Institute Beijing China
| | - Tianyu Wang
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery System Department of Pharmaceutics School of Pharmaceutical Sciences Peking University Beijing China
| | - Qirui Yang
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery System Department of Pharmaceutics School of Pharmaceutical Sciences Peking University Beijing China
| | - Chunyi Hao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) Department of Hepato‐Pancreato‐Biliary Surgery Sarcoma Center, Peking University Cancer Hospital and Institute Beijing China
| | - Tianyan Zhou
- Beijing Key Laboratory of Molecular Pharmaceutics and New Drug Delivery System Department of Pharmaceutics School of Pharmaceutical Sciences Peking University Beijing China
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12
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Tirotta F, Fadel MG, Hodson J, Parente A, Wilkerson H, Almond LM, Ford SJ, Hayes AJ, Desai A, Strauss DC. Association Between Ageing and Short-Term Survival Outcomes in Patients Undergoing Surgery for Primary Retroperitoneal Sarcoma. Ann Surg Oncol 2022; 29:7320-7330. [PMID: 35854029 DOI: 10.1245/s10434-022-12231-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/25/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND As the population ages, more elderly patients are receiving surgery for retroperitoneal sarcoma (RPS). However, high-quality data investigating associations between ageing and prognosis are lacking. Our study aimed to investigate whether ageing is associated with inferior short-term survival outcomes after RPS surgery. PATIENTS AND METHODS Patients undergoing surgery for primary RPS between 2008 and 2019 at two tertiary sarcoma centres were analysed. The primary outcome was 1-year mortality, and the primary explanatory variable was patient age, classified as: < 55, 55-64, 65-74 or 75+ years. RESULTS The 692 patients undergoing surgery (mean age 60.8 ± 13.8 years) had a 1-year mortality rate of 9.4%, which differed significantly by age (p < 0.001), with rates of 7.2%, 6.9%, 8.7% and 22.8% for the < 55, 55-64, 65-74 and 75+ years groups, respectively. The distribution of causes of death also differed significantly by age (p = 0.023), with 22% and 28% of deaths in the 65-74 and 75+ years groups caused by post-operative complications, versus none in the < 55 and 55-64 years groups. On multivariable analysis, age of 75+ years (versus < 55 years) was a significant independent predictor of 1-year mortality [odds ratio (OR) 7.05, 95% confidence interval (CI) 2.63-18.9, p < 0.001]; no significant increase in risk was observed in the 55-64 (OR 0.72, 95% CI 0.28-1.87) or 65-74 (OR 0.89, 95% CI 0.37-2.15) years groups. CONCLUSIONS Post-operative complications are an important cause of deaths in elderly patients. These findings are relevant to decision-making and counselling when surgery is considered for patients with RPS.
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Affiliation(s)
- Fabio Tirotta
- Department of Academic Surgery, Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK. .,Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TH, UK.
| | - Michael G Fadel
- Department of Academic Surgery, Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - James Hodson
- Institute of Translational Medicine, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.,Research Development and Innovation, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alessandro Parente
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - Helene Wilkerson
- Department of Academic Surgery, Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - L Max Almond
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - Samuel J Ford
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - Andrew J Hayes
- Department of Academic Surgery, Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Anant Desai
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - Dirk C Strauss
- Department of Academic Surgery, Sarcoma Unit, The Royal Marsden Hospital NHS Foundation Trust, London, UK
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13
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Retroperitoneal Sarcoma Care in 2021. Cancers (Basel) 2022; 14:cancers14051293. [PMID: 35267600 PMCID: PMC8909774 DOI: 10.3390/cancers14051293] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/22/2022] [Accepted: 02/27/2022] [Indexed: 12/16/2022] Open
Abstract
Soft-tissue sarcomas are biologically heterogenous tumors arising from connective tissues with over 100 subtypes. Although sarcomas account for <1% of all adult malignancies, retroperitoneal sarcomas are a distinct subgroup accounting for <10% of all sarcomatous tumors. There have been considerable advancements in the understanding and treatment of retroperitoneal sarcoma in the last decade, with standard treatment consisting of upfront primary surgical resection. The evidence surrounding the addition of radiation therapy remains controversial. There remains no standard with regards to systemic therapy, including immunotherapy. Adjunctive therapy remains largely dictated by expert consensus and preferences at individual centers or participation in clinical trials. In this 2021 review, we detail the anatomical boundaries of the retroperitoneum, clinical characteristics, contemporary standard of care and well as recent advancements in retroperitoneal sarcoma care. Ongoing international collaborations are encouraged to advance our understanding of this complex disease.
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Tirotta F, Ford SJ. Containing Cumulative Postoperative Morbidity in Patients with Retroperitoneal Sarcoma May Improve Long-Term Prognosis. Ann Surg Oncol 2021; 28:7950-7951. [PMID: 33904002 DOI: 10.1245/s10434-021-10074-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Fabio Tirotta
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Samuel J Ford
- Department of Sarcoma and General Surgery, Midlands Abdominal and Retroperitoneal Sarcoma Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
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