Postoperative Outcome of Surgery with Pancreatic Resection for Retroperitoneal Soft Tissue Sarcoma: Results of a Retrosp
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ORIGINAL ARTICLE
Postoperative Outcome of Surgery with Pancreatic Resection for Retroperitoneal Soft Tissue Sarcoma: Results of a Retrospective Bicentric Analysis on 50 Consecutive Patients Meredith Flacs 1 & Matthieu Faron 1 & Olivier Mir 2 & Fadila Mihoubi 3 & Isabelle Sourouille 1 & Leila Haddag-Miliani 3 & Sarah Dumont 4 & Philippe Terrier 5 & Antonin Levy 6 & Bertrand Dousset 7 & Pascaline Boudou-Rouquette 8 & Axel Le Cesne 4 & Sébastien Gaujoux 9,10 & Charles Honoré 1 Received: 15 July 2020 / Accepted: 12 November 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract Backgrounds Multivisceral resection is the standard treatment for retroperitoneal sarcoma (RPS) during which pancreas resection may be necessary. Methods All consecutive patients operated for RPS with pancreatectomy in 2 expert centers between 1993 and 2018 were retrospectively analyzed. Results Fifty patients (median age: 57 years, IQR: [46–65]) with a primary (n = 33) or recurrent (n = 17) RPS underwent surgery requiring pancreas resection (distal pancreatectomy (DP) (n = 43), pancreaticoduodenectomy (PD) (n = 5), central pancreatectomy (n = 1), and atypical resection (n = 1)). Severe postoperative morbidity (Clavien-Dindo III–IV) was observed in 14 patients (28%), and 7 of them (14%) required reoperation for anastomotic bowel leakage (n = 5), gastric volvulus (n = 1), or hemorrhage (n = 1). Pancreas-related complications occurred in 25 patients (50%): 10 postoperative pancreatic fistulas (POPF) (grade A (n = 12), grade B (n = 6), grade C (n = 1)), 13 delayed gastric emptying (grade A (n = 8), grade B (n = 4), grade C (n = 1)), 1 hemorrhage (grade C). Postoperative mortality was 4% (n = 2), all following PD, caused by a massive intraoperative air embolism and by a multiple organ failure after anastomotic leakage. Pathological analysis confirmed pancreatic involvement in 17 (34%) specimens. Microscopically complete resection (R0) was achieved in 22 (44%) patients. After a follow-up of 60 months, 36 patients (75%) were still alive, among whom 27 without recurrence (56%). Conclusion Pancreatic resection during RPS surgery is associated with significant postoperative morbidity and mortality. PD should be avoided whenever possible while other procedures seemed achievable without excessive morbidity and with long-term survival. Keywords Retroperitoneal soft tissue sarcoma . Pancreas . Surgery . Morbidity . Pancreatectomy
Sébastien Gaujoux and Charles Honoré should be viewed as last coauthors. * Charles Honoré [email protected] Sébastien Gaujoux [email protected] 1
Department of Surgical Oncology, Gustave Roussy, 114, rue Edouard Vaillant, 94805 Villejuif, France
2
Department of Ambulatory Care, Gustave Roussy, Villejuif, France
3
Department of Radiology, Gustave Roussy, Villejuif, France
4
Department of Medical Oncology, Gustave Roussy, Villejuif, France
5
Department of Pathology, Gustave Roussy, Villejuif, France
6
Department of Radiation Therapy, Gustave Roussy, Villejuif, France
7
Department of
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