Surgical Management of Recurrent Retroperitoneal Sarcomas: Experience From a High-Volume Sarcoma Centre: Recurrent...

Retroperitoneal sarcoma (RPS) is a rare and complex malignancy, requiring specialized multidisciplinary care. While a significant progress has been made in managing a primary RPS, there is a limited literature on the outcomes of recurrent RPS (RecRPS). This study evaluates the oncological outcomes of RecRPS at a leading sarcoma referral center in India.

A retrospective analysis was performed for patients with RecRPS who underwent surgery between January 2011 and December 2024. Clinical outcomes were analyzed using Kaplan-Meier method and compared using log-rank test. Extended Cox regression models were used to account for intra-individual correlation, in cases of multiple recurrence. Prentice, William and Peterson model (PWP) CP model (total time) and PWP Gap time (PWP-GT) models were employed to estimate predictors of multiple recurrences.

Out of 285 patients with primary RPS, 160 (56.1%) underwent surgery for a recurrent disease. The median overall survival (OS) was 137.1 months for the entire cohort and 41.92 months in RecRPS. The median OS of patients with 1st recurrence was 38.97 months. For subsequent recurrences, the median OS were 74.94 months (2nd recurrence), 57.4 months (3rd recurrence) and 54.2 months (4th recurrence), respectively. The various clinicopathological parameter associated with multiple recurrences were R+resection or resection with unknown margins, dedifferentiated liposarcoma and leiomyosarcoma, as histopatholologic subtypes; histologic organ invasion (HOI) of the small bowel and vessels, requirement of adjuvant and neoadjuvant therapy, disease progression on neoadjuvant chemotherapy and grade IIIb and IV complications.

While the best chance of cure is at the primary presentation, some patients may experience prolonged disease control even with multiple recurrence, if treated optimally.