Significance of microscopic margin status in completely resected retroperitoneal sarcoma

We determined whether microscopic margin status is an independent prognosticator in patients who underwent complete resection of retroperitoneal sarcoma.

A total of 99 patients with a median age of 55.4 years (range 26.0 to 81.9) underwent complete surgical resection for primary (79) or recurrent (20) retroperitoneal sarcoma between September 1990 and January 2010. Median followup was 36.0 months (range 1.0 to 221.1).

Microscopic involvement of the margins was detected in 24 patients and local recurrence developed in 69 (69.7%). Univariate analysis showed that pain, recurrent disease and higher Fédération Nationale des Centres de Lutte Contre le Cancer grade were associated with an increased risk of local recurrence. On multivariate Cox analysis presenting symptoms and grade were significantly associated with local recurrence-free survival, including pain vs other symptoms (HR 1.7, p = 0.035) and grade 3 vs 1 (HR 2.4, p = 0.028). A total of 25 patients (25.3%) died of retroperitoneal sarcoma. Histological subtype, grade and tumor margin status were prognostic for disease specific survival. Cox regression analysis revealed that certain factors were significantly associated with disease specific survival, including other sarcomas vs liposarcoma (HR 2.8, p = 0.030) and positive vs negative margins (HR 3.4, p = 0.005).

Although complete surgical resection is possible in patients with retroperitoneal sarcoma, the procedure is associated with a high recurrence rate even in patients with negative margins. Microscopically clear margins reliably predict disease specific survival but not local control.