Abstract
BackgroundEn bloc resection of the tumor with adjacent organs is recommended for localized retroperitoneal sarcoma (RPS). However, resection of the pancreas is controversial because it may cause serious complications, such as pancreatic fistula or bleeding. Thus, we evaluated the outcomes of distal pancreatectomy (DP) in pancreas-abutting RPS of the left upper quadrant (LUQ).MethodsWe retrospectively reviewed all consecutive patients who underwent surgery for RPS between September 2001 and April 2020. We selected 150 patients with all or part of their tumor located in the LUQ on preoperative computed tomography. Eighty-six patients who had tumors abutting the pancreas were finally enrolled in our study.ResultsFifty-three patients (53/86; 61.6%) were included in the non-DP group, and 33 patients (33/86; 38.4%) were included in the DP group. Total postoperative complications and complication rates for those Clavien–Dindo grade 3 or higher were similar between the non-DP group and DP group (p = 0.290 and p = 0.550). In the DP group, grade B pancreatic fistulae occurred in 18.2% (6/33) of patients, but grade C pancreatic fistulae were absent, and microscopic pancreatic invasion was noted in 42.4% (14/33) of patients. During multivariate analysis, microscopic pancreatic invasion was deemed a risk factor for local recurrence (p = 0.029). However, there were no significant differences on preoperative computed tomography findings between the pancreatic invasion and non-invasion groups.ConclusionDP is a reasonable procedure for pancreas-abutting RPS located at the LUQ when both complications and complete resection are considered.
Highlights
Soft tissue sarcoma is rare, accounting for less than 1% of all cancers, and retroperitoneal sarcoma (RPS) accounts for about 15% of all soft tissue sarcomas [1]
Total postoperative complications and complication rates for those Clavien–Dindo grade 3 or higher were similar between the non-distal pancreatectomy (DP) group and DP group (p = 0.290 and p = 0.550)
In the DP group, grade B pancreatic fistulae occurred in 18.2% (6/33) of patients, but grade C pancreatic fistulae were absent, and microscopic pancreatic invasion was noted in 42.4% (14/33) of patients
Summary
Soft tissue sarcoma is rare, accounting for less than 1% of all cancers, and retroperitoneal sarcoma (RPS) accounts for about 15% of all soft tissue sarcomas [1]. Surgery to address large tumors is often challenging, complete surgical resection is the only potential curative treatment for patients with localized RPS [3]. The tumor-related mortality of RPS is mainly due to local recurrence (LR) in the absence of distant metastasis [5]. En bloc resection with adjacent structures is recommended to increase the safety margins of RPS treatment [2]. Li et al reported that pancreaticoduodenectomy (PD) is a feasible way to achieve complete resection for right-sided RPS despite the many major complications that may occur [6]. Bagaria et al reported that distal pancreatectomy (DP) for primary RPS can achieve complete resection with acceptable morbidity and oncologic outcomes [7]. En bloc resection of the tumor with adjacent organs is recommended for localized retroperitoneal sarcoma (RPS). We evaluated the outcomes of distal pancreatectomy (DP) in pancreasabutting RPS of the left upper quadrant (LUQ)
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