Severe Postoperative Complications are Associated with Impaired Survival in Primary but not in Recurrent Retroperitoneal
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ORIGINAL ARTICLE – SARCOMA
Severe Postoperative Complications are Associated with Impaired Survival in Primary but not in Recurrent Retroperitoneal Sarcoma Eran Nizri, MD1,4 , Yael Netanyahu, BSc1,4, Fabian Gerstenhaber, MD1,4, Sivan Shamai, MD2, Osnat Sher, MD3, Ofer Merimsky, MD2,4, Guy Lahat, MD1,4, and Joseph M. Klausner, MD1,4 1
Surgical Oncology Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; 2Institute of Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; 3Institute of Pathology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; 4Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
ABSTRACT Background. Retroperitoneal sarcoma (RPS) surgery entails multivisceral resection, which may cause postoperative complications. We assessed the effects of complications on survival to identify their predisposing factors in primary (PRPS) and recurrent (RRPS) RPS. Methods. We retrospectively analyzed our institutional database. Severe postoperative complications (SC) were defined as Clavien-Dindo classification C 3. Predisposing factors for complications were investigated, as was their effect on long-term outcomes. Results. In total, 154 RPS resections (78 PRPS and 76 RRPS) performed between January 2008 and December 2018 were included. Neoadjuvant chemotherapy and multifocal tumors were more common in RRPS than PRPS (34.2% vs. 11.3%, P = 0.001 and 42.1% vs. 10.3%, P \ 0.001, respectively). Although surgical extent in RRPS was limited compared with PRPS (weighted organ score 1 vs. 2, P = 0.01; transfusion requirement 23.6% vs. 35.8%, P = 0.04), SC and mortality rates were comparable. SC rates were 30.1% and 35.5% for PRPS and RRPS,
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-09179-x) contains supplementary material, which is available to authorized users. Society of Surgical Oncology 2020 First Received: 4 June 2020 Accepted: 8 September 2020 E. Nizri, MD e-mail: [email protected]
respectively. NACT rate tended to be higher in PRPS patients with SC (20.8% vs. 7.4%, P = 0.09), whereas weighted organ score and transfusion requirement were increased in RRPS patients with SC (2 vs. 1, P = 0.01; 40.7% vs. 14.3%, P = 0.009, respectively). PRPS patients with SC had decreased overall survival (35 months, 95% confidence interval [CI] 12.2–57.7) compared with those without SC (90 months, 95% CI 71.4–108.5, P = 0.01). Conclusions. Postoperative complications are associated with impaired outcomes in PRPS but not in RRPS. The negative effects of complications on outcomes should be factored to perioperative management.
Retroperitoneal sarcomas (RPS) are a rare and heterogeneous group of mesenchymal tumors.1 They usually present as large masses and, due to their location in the retroperitoneum, are in contact with various major structures, such as the kidneys, colon, duodenum, and major vessels. A macroscopically complete resection is the only curative modality for RPS, whereas other modalities, such
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