Contiguous organ resection is safe in patients with retroperitoneal sarcoma: An ACS-NSQIP analysis

The practice of aggressive contiguous organ resection (COR) of retroperitoneal sarcoma (RPS) is controversial. We examined rates of 30-day morbidity and mortality following resection of RPS utilizing data from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.

From 2005 to 2007, we identified 156 cases of primary malignant neoplasm of the retroperitoneum. Univariate and multivariate analyses were performed using all pre-operative ACS-NSQIP variables for likelihood of post-operative overall morbidity or severe morbidity (composite endpoint including organ space infection, septic shock, acute renal failure requiring dialysis, reoperation, and death). Insufficient events precluded multivariate analysis of mortality as an independent outcome.

Overall 30-day morbidity, severe morbidity, and mortality were 26% (N = 40), 11.5% (N = 18), and 1.3% (N = 2), respectively. Fifty-eight patients (37%) underwent COR, most commonly kidney. American Society for Anesthesiologists classification predicted overall morbidity (OR 3.23, 95% CI 1.33-7.84), while increasing operative time predicted severe morbidity (OR 1.38 per hour, 95% CI 1.05-1.81). COR was not associated with increased 30-day overall morbidity (OR 1.38, 95% CI 0.49-3.89) or severe morbidity (OR 0.78, 95% CI 0.05-13.18).

Rates of post-operative morbidity and mortality are acceptable following RPS resection, even in the setting of multi-visceral resection. COR should not be viewed as a contraindication to complete RPS resection.