A Prospective Observational Study of Multivisceral Resection for Retroperitoneal Sarcoma: Clinical and Patient-Reported
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ORIGINAL ARTICLE – SARCOMA
A Prospective Observational Study of Multivisceral Resection for Retroperitoneal Sarcoma: Clinical and Patient-Reported Outcomes 1 Year After Surgery Marco Fiore, MD, FACS1 , Cinzia Brunelli, MSc2, Rosalba Miceli, PhD3, Michele Manara, MD1, Susanna Lenna, MD4, Nicolo` N. Rampello, RN1, Dario Callegaro, MD1, Chiara Colombo, MD1, Stefano Radaelli, MD1, Sandro Pasquali, PhD, MD1, Augusto T. Caraceni, MD2 , and Alessandro Gronchi, MD1 1
Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; 2Palliative Care, Pain Therapy and Rehabilitation, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; 3Clinical Epidemiology and Trial Organization, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; 4Department of Surgery, ASST Ovest Milanese, Legnano Hospital, Legnano, Italy
ABSTRACT Background. Primary retroperitoneal sarcoma (RPS) may require multivisceral resection (MVR). Clinical outcome (morbidity and renal function) and quality of life (QoL) are not as well reported as the oncologic outcome. Methods. Patients with primary RPS who underwent surgery between 2014 and 2016 were prospectively enrolled in an observational longitudinal study. At baseline, then at 4 and 12 months, the study measured Clavien– Dindo morbidity, estimated glomerular filtration rate (EGFR), EORTC QLQ-C30, QLQ-CR29, DN4 (neuropathic pain [NP]), lower-extremity functional scale (LEFS), and the brief pain inventory. The primary end point was the difference in global health status (GHS/QoL). The secondary end points were EGFR changes, difference in other QLQ-C30 scales, pain intensity, NP, and LEFS. The study is registered at ClinTrials.gov (NCT03480399). Results. Of 74 patients, 58 were evaluable. Morbidity grade 3 or higher was 24.1%, and mortality was 1.3%. After nephrectomy, the mean 1-year EGFR change was -33.9%. The GHS/QoL at baseline was 58.6 and had increased of 6.9 points at 1 year, comparable with that of
Ó Society of Surgical Oncology 2020 First Received: 14 August 2020 Accepted: 10 October 2020 M. Fiore, MD, FACS e-mail: [email protected]
the general population. A transient worsening in pain and diarrhea had recovered at 12 months. Average pain was mild and did not differ at 12 months. However, NP was found in 41.4% of the patients and was significantly associated with resection of the psoas muscle. At baseline, LEFS was already lower than the normative value, and worsening after surgery was not clinically relevant. Conclusion. A QoL measure after MVR in primary RPS is complex and requires multiple tools. Whereas overall MVR is safe and associated with an improvement in GHS/ QoL, chronic NP is frequent and deserves specific attention. Pre-surgery rehabilitation tracks may help to prevent or reduce chronic NP.
Complete gross resection is the cornerstone of primary retroperitoneal sarcoma (RPS) management. Surgery should be aimed at achieving macroscopically complete resection of tumor, minimizing microscopically positive margins. In the modern era,
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