Aggressive surgical treatment of retroperitoneal sarcoma: long-term experience of a single institution

Surgery is the main modality in the therapy of retroperitoneal soft-tissue sarcomas (RSTS). A retrospective study was undertaken to evaluate the results of aggressive surgical treatment in a series of patients of primary and recurrent retroperitoneal sarcomas. A review of 166 consecutive patients with RSTS operated on at the Institute of Oncology in Ljubljana from 1975 through 2005 were reviewed. A total of 269 operations were performed on 166 patients. The five- and ten-year survival rates of patients with localized sarcoma were 52% and 38%, respectively. Factors that influenced the survival were distant metastases, tumor grade, and type of resection. The patients with R0 resections had a five-year survival rate of 75% and a ten-year survival rate of 65%; the respective rates for the patients with R1 resections were 25% and 7% (p < 0.00001). When only R0 resection was considered, referral status (primary, residual, recurrent RSTS) influenced survival (p = 0.004). The quality of initial surgery is a crucial prognostic factor to predicting survival in patients with RSTS. Complete surgical resection without microscopic residuum and contamination is likely to offer the best chances for long-term survival. Unless no other treatment modalities are available, aggressive surgery for recurrent sarcoma is recommended.