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Surgical resection for primary retroperitoneal liposarcoma: Analysis of 153 patients treated and followed at a single
Haicheng Gao1, Shibo Liu1, Boyuan Zou1
1Department of Retroperitoneal Tumor Surgery, Peking University International Hospital, Beijing, China.
Background:
This study aimed to identify key prognostic factors influencing disease-free survival (DFS) and overall survival (OS) in patients with primary retroperitoneal liposarcoma (PRPLS), and to evaluate the impact of surgical approach (en bloc vs. piecemeal resection) and combined multivisceral resection on oncologic outcomes.
Methods:
A retrospective cohort study included 153 consecutive patients with PRPLS undergoing surgery (2014-2023). Clinicopathological data, surgical details, and adjuvant therapies were analyzed. Primary endpoints were disease-free survival (DFS) and overall survival (OS), analyzed using Kaplan-Meier methods and Cox regression.
Results:
Median age was 57 years, with male predominance (59.5%). Tumors were frequently large (52.3% >20 cm), multifocal (47.7%), and dedifferentiated (DDLS, 66.0%). Curative-intent resection (R0/R1) was achieved in 93.5% (143/153), mostly via open laparotomy. En bloc resection was performed in 73.2% (112/153); combined multivisceral resection was required in 52.9% (81/153). Median follow-up was 42 months. For R0/R1 patients (n = 137), 5-year DFS was 36.5% and 5-year OS was 77.6%. Multivariate analysis identified independent predictors of inferior DFS: piecemeal resection (HR = 1.81, P = 0.033), combined multivisceral resection (HR = 2.06, P = 0.003), and DDLS histology (HR = 1.81, P = 0.030). Combined multivisceral resection (HR = 5.12, P = 0.001) and DDLS (HR = 2.93, P = 0.022) independently predicted worse OS. En bloc resection significantly improved 5-year DFS (41.1% vs. 16.1%, P = 0.001) and showed a strong trend towards improved OS (P = 0.051). Neoadjuvant/adjuvant therapy demonstrated no significant survival benefit.
Conclusions:
DDLS histology, piecemeal resection, and requirement for combined multivisceral resection are key determinants of poor prognosis in PRPLS. En bloc radical resection with negative margins (R0) should be the primary surgical goal when feasible. The role of adjuvant therapies remains uncertain and warrants prospective investigation.
