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Long-term Results With Primary Retroperitoneal Tumors

Long-term Results With Primary Retroperitoneal Tumors Abstract • Primary retroperitoneal tumors represent a variety of lesions, with different treatments and prognoses. Of 182 patients in our study, retroperitoneal tumor was recognized preoperatively in only 39% of them. Sarcomas were most common (43% of patients), followed by lymphomas (23%), benign tumors (11%), undifferentiated malignant tumors (11%), carcinomas (8%), and germ cell tumors (4%). In 81 patients since 1960, the resection rate was 50%. Operative determinants of resectability were pathologic category and grade and extent of tumor. Resection included segments of the gastrointestinal tract (30% of the patients), kidney (25%), and pancreas, bladder, spleen, aorta, and vena cava (for each, 5% or less of the patients). The operative mortality was 6%. Tumor caused late death in 95% of the patients. Pathologic findings were a significant determinant of survival in the 81 patients. For sarcomas, 69% of the patients underwent resection, and the 1- and 5-year actuarial survival rates were 80% and 43%, respectively. Sixty percent of these patients underwent multiple operations. For lymphomas, most patients were treated with radiotherapy and chemotherapy; the 1- and 5-year survival rates were 67% and 35%, respectively. Benign tumors, almost all resected, yielded a 5-year survival rate of 100%. Undifferentiated tumors and carcinomas, most treated with radiotherapy and chemotherapy, had a 1-year survival rate of less than 33%. Other determinants of survival were age, weight loss, grade of tumor, and extent of tumor. Patients who underwent palliative resection had the same survival rate as patients who underwent biopsy alone. Complete surgical resection, if possible, is associated with the best survival rates for primary retroperitoneal tumors, and palliative resection is beneficial only to relieve symptoms. (Arch Surg. 1989;124:1168-1173) References 1. Glenn J, Sindelar WF, Kinsella T, et al. Results of multimodality therapy of resectable soft-tissue sarcomas of the retroperitoneum . Surgery . 1985;97:316-324. 2. Armstrong JR, Cohn L. Primary malignant retroperitoneal tumors . Am J Surg . 1965;110:937-945.Crossref 3. Pack GT, Tabah EJ. Primary retroperitoneal tumors: a study of 120 cases . Int Abstracts Surg . 1954;99:313-337. 4. Parkinson MC, Chabrel CM. Clinicopathological features of retroperitoneal tumours . Br J Urol . 1984;56:17-23.Crossref 5. Braasch JW, Mon AB. Primary retroperitoneal tumors . Surg Clin North Am . 1967;47:663-678. 6. Salvadori B, Cusumano F, Delle donne V, De Lellis R, Conti R. Surgical treatment of 43 retroperitoneal sarcomas . Eur J Surg Oncol . 1986;12:29-33. 7. McGrath PC, Neifield JP, Lawrence W, et al. Improved survival following complete excision of retroperitoneal sarcomas . Ann Surg . 1984;200:200-204.Crossref 8. Cody HS, Turnbull AD, Fortner JG, Hajdu SI. The continuing challenge of retroperitoneal sarcomas . Cancer . 1981;47:2147-2152.Crossref 9. Wist E, Solheim P, Jacobsen AB, Blom P. Primary retroperitoneal sarcomas: a review of 36 cases . Oncology . 1985;24:305-310. 10. Felix EL, Wood DK, Das Gupta TK. Tumors of the retroperitoneum . Curr Probl Cancer . 1981;6:3-47.Crossref 11. Fortner JG, Martin S, Hajdu S, Turnbull A. Primary sarcoma of the retroperitoneum . Semin Oncol . 1981;8:180-184. 12. Adam YG, Oland J, Halevy A, Reif R. Primary retroperitoneal soft-tissue sarcomas . J Surg Oncol . 1984;25:8-11.Crossref 13. Stower MJ, Hardcastle JD. Malignant retroperitoneal sarcoma: a review of 32 cases . Clin Oncol . 1982;8:257-263. 14. North JP. Primary tumors of the retroperitoneum . Ann Surg . 1960;151:693-704.Crossref 15. Jeffrey RR, Maloney DJ, Grigor KM. An unusual retroperitoneal seminoma . Br J Urol . 1987;59:93-94.Crossref 16. Juul N, Torp-Pedersen S, Holm HH. Ultrasonically guided fine needle aspiration biopsy of retroperitoneal mass lesions . Br J Radiol . 1984;57:4346.Crossref 17. Karp W, Hafstrom LO, Jonsson PE. Retroperitoneal sarcoma: ultrasonographic and angiographic evaluation . Br J Radiol . 1980;53:525-531.Crossref 18. Costa J, Wesley RA, Glatstein E, Rosenberg SA. The grading of soft tissue sarcomas: results of a clinicohistopathologic correlation in a series of 163 cases . Cancer . 1984;53:530-541.Crossref 19. Harrison LB, Gutierrez E, Fischer JJ. Retroperitoneal sarcomas: the Yale experience and a review of the literature . J Surg Oncol . 1986;32:159-164.Crossref 20. Storm FK, Eilber FR, Mirra J, Morton DL. Retroperitoneal sarcomas: a reappraisal of treatment . J Surg Oncol . 1981;17:1-7.Crossref 21. Karakousis CP, Velez AF, Emrich LJ. Management of retroperitoneal sarcomas and patient survival . Am J Surg . 1985;150:376-380.Crossref 22. Glenn J. Retroperitoneal sarcoma: an unsolved problem . Probl Gen Surg . 1985;2:311-321. 23. Reitan JB, Kaalhus O, Brennhovd IO, Sager EM, Stenwig AE,TalleK. Prognostic factors in liposarcoma . Cancer . 1985;55:2482-2490.Crossref 24. Ros PR, Viamonte M, Rywlin AM. Malignant fibrous histiocytoma: mesenchymal tumor of ubiquitous origin . AJR . 1984;142:753-759.Crossref 25. Bohle A, Studer UE, Sonntag RW, Scheidegger JR. Primary or secondary extragonadal germ cell tumors? J Urol . 1986;135:939-943. 26. Bengmark S, Hafstrom L, Jonsson P, Karp W, Nordgren H. Retroperitoneal sarcoma treated by surgery . J Surg Oncol . 1980;14:307-314.Crossref 27. Wiley AL, Wirtanen GW, Joo P, et al. Clinical and theoretical aspects of the treatment of surgically unresectable retroperitoneal malignancy with combined intra-arterial actinomycin-D and radiotherapy . Cancer . 1975;36:107-122.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Long-term Results With Primary Retroperitoneal Tumors

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Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1989.01410100070012
Publisher site
See Article on Publisher Site

Abstract

Abstract • Primary retroperitoneal tumors represent a variety of lesions, with different treatments and prognoses. Of 182 patients in our study, retroperitoneal tumor was recognized preoperatively in only 39% of them. Sarcomas were most common (43% of patients), followed by lymphomas (23%), benign tumors (11%), undifferentiated malignant tumors (11%), carcinomas (8%), and germ cell tumors (4%). In 81 patients since 1960, the resection rate was 50%. Operative determinants of resectability were pathologic category and grade and extent of tumor. Resection included segments of the gastrointestinal tract (30% of the patients), kidney (25%), and pancreas, bladder, spleen, aorta, and vena cava (for each, 5% or less of the patients). The operative mortality was 6%. Tumor caused late death in 95% of the patients. Pathologic findings were a significant determinant of survival in the 81 patients. For sarcomas, 69% of the patients underwent resection, and the 1- and 5-year actuarial survival rates were 80% and 43%, respectively. Sixty percent of these patients underwent multiple operations. For lymphomas, most patients were treated with radiotherapy and chemotherapy; the 1- and 5-year survival rates were 67% and 35%, respectively. Benign tumors, almost all resected, yielded a 5-year survival rate of 100%. Undifferentiated tumors and carcinomas, most treated with radiotherapy and chemotherapy, had a 1-year survival rate of less than 33%. Other determinants of survival were age, weight loss, grade of tumor, and extent of tumor. Patients who underwent palliative resection had the same survival rate as patients who underwent biopsy alone. Complete surgical resection, if possible, is associated with the best survival rates for primary retroperitoneal tumors, and palliative resection is beneficial only to relieve symptoms. (Arch Surg. 1989;124:1168-1173) References 1. Glenn J, Sindelar WF, Kinsella T, et al. Results of multimodality therapy of resectable soft-tissue sarcomas of the retroperitoneum . Surgery . 1985;97:316-324. 2. Armstrong JR, Cohn L. Primary malignant retroperitoneal tumors . Am J Surg . 1965;110:937-945.Crossref 3. Pack GT, Tabah EJ. Primary retroperitoneal tumors: a study of 120 cases . Int Abstracts Surg . 1954;99:313-337. 4. Parkinson MC, Chabrel CM. Clinicopathological features of retroperitoneal tumours . Br J Urol . 1984;56:17-23.Crossref 5. Braasch JW, Mon AB. Primary retroperitoneal tumors . Surg Clin North Am . 1967;47:663-678. 6. Salvadori B, Cusumano F, Delle donne V, De Lellis R, Conti R. Surgical treatment of 43 retroperitoneal sarcomas . Eur J Surg Oncol . 1986;12:29-33. 7. McGrath PC, Neifield JP, Lawrence W, et al. Improved survival following complete excision of retroperitoneal sarcomas . Ann Surg . 1984;200:200-204.Crossref 8. Cody HS, Turnbull AD, Fortner JG, Hajdu SI. The continuing challenge of retroperitoneal sarcomas . Cancer . 1981;47:2147-2152.Crossref 9. Wist E, Solheim P, Jacobsen AB, Blom P. Primary retroperitoneal sarcomas: a review of 36 cases . Oncology . 1985;24:305-310. 10. Felix EL, Wood DK, Das Gupta TK. Tumors of the retroperitoneum . Curr Probl Cancer . 1981;6:3-47.Crossref 11. Fortner JG, Martin S, Hajdu S, Turnbull A. Primary sarcoma of the retroperitoneum . Semin Oncol . 1981;8:180-184. 12. Adam YG, Oland J, Halevy A, Reif R. Primary retroperitoneal soft-tissue sarcomas . J Surg Oncol . 1984;25:8-11.Crossref 13. Stower MJ, Hardcastle JD. Malignant retroperitoneal sarcoma: a review of 32 cases . Clin Oncol . 1982;8:257-263. 14. North JP. Primary tumors of the retroperitoneum . Ann Surg . 1960;151:693-704.Crossref 15. Jeffrey RR, Maloney DJ, Grigor KM. An unusual retroperitoneal seminoma . Br J Urol . 1987;59:93-94.Crossref 16. Juul N, Torp-Pedersen S, Holm HH. Ultrasonically guided fine needle aspiration biopsy of retroperitoneal mass lesions . Br J Radiol . 1984;57:4346.Crossref 17. Karp W, Hafstrom LO, Jonsson PE. Retroperitoneal sarcoma: ultrasonographic and angiographic evaluation . Br J Radiol . 1980;53:525-531.Crossref 18. Costa J, Wesley RA, Glatstein E, Rosenberg SA. The grading of soft tissue sarcomas: results of a clinicohistopathologic correlation in a series of 163 cases . Cancer . 1984;53:530-541.Crossref 19. Harrison LB, Gutierrez E, Fischer JJ. Retroperitoneal sarcomas: the Yale experience and a review of the literature . J Surg Oncol . 1986;32:159-164.Crossref 20. Storm FK, Eilber FR, Mirra J, Morton DL. Retroperitoneal sarcomas: a reappraisal of treatment . J Surg Oncol . 1981;17:1-7.Crossref 21. Karakousis CP, Velez AF, Emrich LJ. Management of retroperitoneal sarcomas and patient survival . Am J Surg . 1985;150:376-380.Crossref 22. Glenn J. Retroperitoneal sarcoma: an unsolved problem . Probl Gen Surg . 1985;2:311-321. 23. Reitan JB, Kaalhus O, Brennhovd IO, Sager EM, Stenwig AE,TalleK. Prognostic factors in liposarcoma . Cancer . 1985;55:2482-2490.Crossref 24. Ros PR, Viamonte M, Rywlin AM. Malignant fibrous histiocytoma: mesenchymal tumor of ubiquitous origin . AJR . 1984;142:753-759.Crossref 25. Bohle A, Studer UE, Sonntag RW, Scheidegger JR. Primary or secondary extragonadal germ cell tumors? J Urol . 1986;135:939-943. 26. Bengmark S, Hafstrom L, Jonsson P, Karp W, Nordgren H. Retroperitoneal sarcoma treated by surgery . J Surg Oncol . 1980;14:307-314.Crossref 27. Wiley AL, Wirtanen GW, Joo P, et al. Clinical and theoretical aspects of the treatment of surgically unresectable retroperitoneal malignancy with combined intra-arterial actinomycin-D and radiotherapy . Cancer . 1975;36:107-122.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Oct 1, 1989

References