Abstract
BackgroundEn bloc resection of retroperitoneal sarcoma (RPS) with adjacent organs such as pancreatic head and duodenum is challenging for surgeons. This mono-institutional study aims to evaluate the feasibility, safety, and outcome of performing pancreaticoduodenectomy (PD) during RPS resection.MethodsThe clinical data of RPS patients who underwent PD at the Sarcoma Center of Peking University Cancer Hospital from January 2011 to December 2019 was collected and analyzed.ResultsTwenty-seven patients out of a total of 264 surgically treated RPS underwent PD. The main pathological subtype was liposarcoma. All patients received concomitant resection of a median of three additional organs (range: 1–5), including 11 patients (40.7%) who underwent inferior vena cava resection and one patient who underwent segmental superior mesenteric-portal vein resection. Microscopic tumor infiltration to the duodenum or pancreas was observed in 81.5% of patients. Major complications occurred in 40.7% of patients; the reoperation rate was 22.2%. One patient (3.7%) died from liver abscess postoperatively. During a median follow-up of 18.9 months, 15 patients (55.6%) developed locally recurrent disease; two patients (7.4%) also had pulmonary metastases additionally. Twelve patients (44.4%) died from local relapse eventually.ConclusionPD during RPS resection is feasible, and it may be necessary to achieve complete resection. However, considering the complexity and risk, it should be performed by an experienced surgical team. The long-term survival benefit of this procedure should be verified by further large-scale multi-institutional studies.
Highlights
Retroperitoneal sarcomas (RPS) are rare tumors composed of numerous heterogeneous histological subtypes, with an expected incidence of less than three cases per million people each year in the United States [1]
Differing from sarcomas arising in the extremity and trunk, local control of RPS poses a significant challenge due Retroperitoneal Sarcoma, Liposarcoma, Pancreaticoduodenectomy, Resection, Survival to the massive size and potential involvement of adjacent organs, vessels, and other structures
152 patients (57.6%) had primary RPS who were first seen at our institution and 112 patients (42.4%) had recurrent RPS
Summary
Retroperitoneal sarcomas (RPS) are rare tumors composed of numerous heterogeneous histological subtypes, with an expected incidence of less than three cases per million people each year in the United States [1]. Complete resection remains the only chance of cure for RPS. The goal of surgery should be to achieve macroscopically complete resection, with a single specimen encompassing the tumor and adjacent organs, and to minimize microscopically positive margins. Resections of some crucial anatomic structures such as the pancreas, duodenum, inferior vena cava (IVC), and aorta substantially are with greater risks for morbidity and death. En bloc resection of retroperitoneal sarcoma (RPS) with adjacent organs such as pancreatic head and duodenum is challenging for surgeons. This monoinstitutional study aims to evaluate the feasibility, safety, and outcome of performing pancreaticoduodenectomy (PD) during RPS resection
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