Right primary retroperitoneal sarcoma requiring liver resection: A 20-year experience from three European referral...

Liver resection is infrequently required during multivisceral surgery for right-sided retroperitoneal sarcomas (RPS), and outcomes in this setting remain poorly defined. This study aimed to better characterize perioperative and oncologic outcomes in this subgroup.

We conducted a retrospective cohort study across three tertiary centers, including adult patients (≥18 years) who underwent liver resection for macroscopic tumor infiltration during surgery for primary right-sided RPS between January 1, 2004, and June 30, 2024. Adverse events were graded using the Clavien-Dindo classification. Overall survival (OS) was estimated using the Kaplan-Meier method.

Among 826 patients undergoing surgery for right-sided RPS, 24 (3%) required concomitant liver resection. Procedures included single segmentectomy (n = 13, 54%), bisegmentectomy (n = 5, 21%), right hepatectomy (n = 5, 20%), and left hepatectomy (n = 1, 4%). All patients underwent additional organ resection, most commonly colon or kidney. R0/R1 resection was achieved in all cases. Major complications (Clavien-Dindo grade III-IV) occurred in six patients (25%), and one patient (4%) died from intraoperative hemorrhage. After a median follow-up of 94.5 months (IQR, 19-105), estimated 3- and 5-year OS rates were 71% (95% CI, 52-90) and 46% (95% CI, 27-65), respectively.

Liver resection in the context of multivisceral resection for primary RPS is feasible and it is associated to prolonged survival in almost half of the patients. Liver involvement should not be considered an absolute contraindication in selected patients. These complex procedures should be performed in high-volume centers with expertise in both sarcoma and hepatobiliary surgery.