Use of extent surgery via intraperitoneal route to improve iliopsoas sarcoma local control.

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e20508 Background: Sarcomas of the iliopsoas compartment exhibit high local recurrence rates because it is one of the most inaccessible areas. Methods: We analyzed all iliopsoas soft tissue sarcomas addressed for surgery in our institution from 1997 to 2010 in a prospective data base. Surgical technique and histological specimens were prospectively evaluated. Concerning primaries, the endpoints were local recurrence, distant metastasis and overall survival (OS) analyzed by Cox model. Results: There were 32 patients (pts): 29 primaries (including 8 second extended resection after initial unplanned surgery) and 3 recurrences. Mean tumor size (cm) was 14.5 (12 -17) French Sarcoma Group grades were: 1 (n=10), 2 (n=9), 3 (n=12). Histological subtypes were liposarcoma n=12, leio and rhadomyosarcoma n=8, MPNST n=4, others n=8. Main symptoms were femoral palsy (n=10) and palpation of a mass (n=16). Twenty two pts received neoadjuvant treatment (17 chemotherapy, 5 radiotherapy), with 10 objective responses. Intraperitoneal route with chevron incision and section of the inguinal ligament was used for 30 pts. All patients had one bloc resection without intraperitoneal rupture. Femoral nerve resection, nephrectomy, colectomy and vascular resection with bypass were added to the myomectomy for 21, 4, 7 and 6 pts respectively. Mean blood loss (ml) was 540 (200-4000). One pt died post operatively of heart attack, 3 pts had percutaneous drainage of post operative collection. Quality of resection was R0 n=19 pts, R1 n=13 pts. After re excision, residual tumor was found in all the pts (microscopic n=2 pts, macroscopic n=6 pts). Clear median minimum margin was 2 mm (1-30). With a median follow up of 38 months, 3 pts developed local recurrence and sarcomatosis: all the 3 concerned re excision after inadequate initial surgery with tumor rupture. Six high grade pts developed metastasis. The 5-year local recurrence metastatic rate and OS were 16.3% and 31.5% and 61.8% respectively. Conclusions: Intraperitoneal route allows complete monobloc resections of large iliopsoas sarcomas, associated with adjacent organs when necessary. It improves local control compare to extra peritoneal route and historic data.