Complete Surgical Resection in Retroperitoneal Sarcoma

Evidence Supporting Complete Surgical Resection

Complete surgical resection with negative margins is a potentially curative treatment for nonmetastatic primary retroperitoneal sarcomas, as recommended by the National Comprehensive Cancer Network 1, 2
In a large single-institution series of 500 patients, median survival was 103 months for patients who underwent complete resection with grossly negative margins compared to only 18 months for those with incomplete resection 1
The optimal time for surgical resection with curative intent is at primary presentation, according to the National Comprehensive Cancer Network guidelines 3

The margin status after surgery is a critical factor associated with long-term disease-free survival, with the National Comprehensive Cancer Network emphasizing the importance of negative margins 1
Aggressive surgical approaches such as complete compartmental resection and liberal visceral en bloc resection performed in high-volume centers have shown improved local control, as reported by the National Comprehensive Cancer Network 1
Resection often necessitates ipsilateral nephrectomy, hemicolectomy, or psoas fascia/muscle resection to minimize microscopic positive margins, as noted in guidelines from the National Comprehensive Cancer Network 3

Given the close proximity of retroperitoneal sarcomas to critical structures, complete surgical resection is achieved in fewer than 70% of patients, highlighting the need for specialized surgical expertise 1

The role of neoadjuvant chemotherapy versus adjuvant chemotherapy has not been evaluated in randomized clinical trials for retroperitoneal sarcomas, according to the National Comprehensive Cancer Network 1
An analysis of 8,653 patients with resected retroperitoneal soft tissue sarcomas revealed worse overall survival in the surgically resected cohort receiving chemotherapy versus those who underwent surgery alone (40 vs 52 months), as reported by the National Comprehensive Cancer Network 1
Evidence for the effectiveness of chemotherapy in retroperitoneal sarcomas is limited and does not show a clear survival benefit, as noted by the European Society for Medical Oncology and the National Comprehensive Cancer Network 4, 5