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Grade and Survival

Toni Ferrario, MD; Constantine P. Karakousis, MD, PhD

Arch Surg. 2003;138:248-251.

Background  The survival of patients with retroperitoneal sarcomas depends on the feasibility of complete resection and the grade of the tumor.

Hypothesis  A high rate of complete resection, wide rather than local excision when feasible, and a policy of prompt reoperation for local recurrence all improve survival.

Methods  A review of 130 consecutive patients with retroperitoneal soft tissue sarcomas (1977-2001).

Results  The complete resectability rate was 95%, being 99% (78/79) for the primary tumors and 90% (46/51) for tumors referred with local recurrence. Local recurrence after complete resection occurred in 41% (32/79) of those with primary tumors and in 61% (31/51) of those referred with local recurrence (P = .06). The local recurrence rate was 63% after local excision and 39% after wide resection (P = .02). Of 83 patients with relapse, 37 (45%) were rendered surgically disease free. The estimated 5-year (10-year in parentheses) survival from the first surgery at our center was 65% (56%) for patients with primary tumors and 53% (34%) for patients referred with local recurrence (P = .23). For the primary tumors, the 5- and 10-year survival rates were 70% and 60%, respectively, after wide resection and 47% and 39%, respectively, after local excision (P = .04). For the primary tumors, the 5-year survival was 92%, 54%, and 48% for grades I, II, and III, respectively (P = .02). For those referred with local recurrence, the figures were 76%, 45%, and 19% for grades I, II, and III, respectively (P<.001).

Conclusions  A high resectability rate (95%) is possible in retroperitoneal sarcomas. The survival estimates are similar to those following resection of extremity soft tissue sarcomas given an effective reoperation policy for local recurrences. Wide resection lowers the local recurrence and improves survival significantly. Survival varies significantly according to the grade of the tumor.

From the Departments of Surgery, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Kaleida Health, and the Veterans Affairs Medical Center, Buffalo.

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