Primary Retroperitoneal Sarcomas: The Role of Surgical Treatment

Abstract

Malignant tumors arising from the anatomic structures of the retroperitoneal space are rare [l--5]; therefore, it has been difficult to accurately assess their prognosis and clearly delineate the role that surgical excision plays in their overall therapy. Using their embryologic origin and histologic characteristics, Ackerman [6] categorized the malignant tumors of the retroperitoneal space as follows: tumors of mesodermal origin including liposarcoma, leiomyosarcoma, fibrosarcoma, rhabdomyosarcoma, lymphangiosarcoma, lymphoma, hemangiosarcoma and xanthogranuloma; tumors of nervous origin including schwannoma, neuroblastoma, malignant paraganglioma and malignant pheochromocytoma; and tumors arising from embryonic remnants, primarily malignant teratoma and chordoma. Most malignant retroperitoneal tumors are of mesodermal origin as documented in three important reports. In 1954, Pack and Tabah [5] studied 103 cases; 54 percent of them were sarcomas and 24 percent lymphomas. In 1967, Braasch and Mon [I] analyzed 88 cases; 43 percent of them were sarcomas and 32 percent lymphomas. In 1970, Gill et al [7] found that 70 percent of their 22 cases were sarcomas and 15 percent were lymphomas. In all three series, malignant retroperitoneal tumors originating from nervous tissue or embryonic remnants, or with undifferentiated histologic features, comprised less than 25 percent of the cases analyzed. Because lymphomas originating in the abdominal cavity frequently involve the retroperitoneal space and their course and management differ often from those of sarcomatous tumors, they were excluded. This study attempts to elicit factual information that would provide reliable guidelines for establishing the best plan for diagnosis and therapy, and an accurate