Received: 2 October 2017
Accepted: 14 October 2017
Surgical morbidity in retroperitoneal
Andrea J. MacNeill MD, MSc
Marco Fiore MD
Division of Surgical Oncology, British
Columbia Cancer Agency, Vancouver, British
Department of Surgery, University of British
Columbia, Vancouver, British Columbia,
Department of Surgery, Fondazione IRCCS
Istituto Nazionale dei Tumori, Milan, Italy
Andrea J MacNeill, Diamond Health Care
Center, 5199-2775 Laurel St, Vancouver,
British Columbia, Canada V5Z 1M9.
Resection of retroperitoneal sarcoma (RPS) typically involves multivisceral resection.
The morbidity of RPS resection has decreased over time despite widespread adoption
of radical resection. Certain patterns of resection are associated with higher
complication rates and elderly patients are at increased risk of morbidity. Administra-
tion of preoperative radiotherapy does not increase morbidity, but intraoperative and
brachytherapy techniques are associated with heightened toxicities. Long-term
functional outcomes and quality of life scores after RPS resection are acceptable.
adverse events, mortality, quality of life, radical resection, retroperitoneal sarcoma
Surgery is the mainstay of curative-intent treatment for retroperitoneal
sarcoma (RPS). Given that these tumors typically grow to a considerable
size prior to detection and can often involve multiple organs, definitive
surgery frequently requires a complex, multivisceral resection. In order
to devise tailored treatment strategies for individual patients and to
counsel them accordingly, sarcoma surgeons must be able to appreciate
the anticipated morbidity of a proposed procedure. The literature
surrounding the short- and long-term outcomes following resection of
RPS is scant and limited by considerable heterogeneity in patient
populations and surgical approach. Accepting these limitations, the data
available to guide decision-making are reviewed here.
EXTENT OF SURGERY AND
Over the past decade, there has been a paradigm shift toward a radical
surgical approach to RPS. In 2009, two European centers published
data suggesting improved oncologic outcomes with liberal en bloc
resection of organs adhering to, but not necessarily invaded by, RPS.
Gronchi et al reported significantly reduced local recurrence rates with
radical resection compared to an historical cohort who underwent
marginal excision at the same institution. With longer follow-up, this
improvement in local control was found to be associated with
improved overall survival.
The evolution toward more radical
resection generated debate regarding the expectation of increased
operative morbidity and whether this might offset or even negate any
This question was investigated by the Transatlantic Retroperito-
neal Sarcoma Working Group (TARPSWG), an international collabora-
tion of sarcoma centers. The eight founding centers pooled their
contemporary 10-year data to generate the largest reported experi-
ence of RPS resection to date.
A total of 1007 patients underwent
resection for primary, localized RPS from 2002 to 2011. All centers
ascribed to a radical resection philosophy, with a median of two organs
resected. The 30-day mortality rate in this series was 1.8%, with 16.4%
of patients suffering a major complication (Clavien-Dindo ≥3) and
10.5% requiring reoperation. The most common adverse events were
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© 2018 The Authors. Journal of Surgical Oncology Published by Wiley Periodicals, Inc.
wileyonlinelibrary.com/journal/jso J Surg Oncol. 2018;117:56–61.