Management of Retroperitoneal Soft Tissue Sarcomas

M. AL-Obaidi, Safa; A. AL-Wadees, Alaa; Abd-Zaid Akool, Mohammed

	Management of Retroperitoneal Soft Tissue Sarcomas
Iraqi Postgraduate Medical Journal
Article 1, Volume 12, Issue 2, 2013, Pages 166-174 PDF (0 K)
Authors
Safa M. AL-Obaidi; Alaa A. AL-Wadees; Mohammed Abd-Zaid Akool
Abstract
ABSTRACT: Hospital , Baghdad. *Department of surgery ,Kufa Teaching Hospital , Najaf. BACKGROUND: Most retroperitoneal tumors are malignant and about one third are soft tissue sarcomas. Sarcomas are uncommon malignant tumors arising from mesenchymaltissue . Retroperitoneal sarcomas account for approximately 10%-15% of soft tissue sarcomas and less than 1% of all malignant neoplasms. Surgery is the only curative treatment for retroperitoneal soft tissue sarcomas. OBJECTIVE: To define the best extent of surgery that would optimize the safe margins on retroperitoneal soft tissue sarcomas , where the recurrence of tumor greatly depends on feasibility of complete resection and the grade of tumor. PATIENTS AND METHODS: Between June 2007 and December 2010,28 patients (female 16,male 12, mean age; 43.93 years, range18-69 years)were evaluated for survival and response to therapy by gender, age ,preoperative symptoms ,symptoms duration , primary or recurrent tumors , the extended of surgical resection, or palliative procedures .Complete resection was defined as removal of gross tumor with histologically confirmed clean resection margins. RESULTS: Eighteen patients(64%) out of 28 patients under went simple surgical resection ,5 patients(28%)underwent compartmental resection (systematic resection of noninvolved contiguous organs),1 patient (3%) underwent enucleation of tumor ,while debulking done in 4 patients (15%). The surgical resection margin was involved only in one patient (due to tumor rupture during resection) of those patients underwent compartmental resections, it’s was free in only (10/18,56%) patients underwent simple resection ,while it was involved in all tumors removed with enucleation or debulking (incomplete resection) . The recurrence of tumor greatly depends on state of surgical margin in resected sample (pvalue=0.001 , significantly associated). The histopathological grade of tumor on the other hand also proved an important factor in the recurrence of tumor where it was higher with high grade tumor versus low grade tumor (Pvalue=0.001 , significantly associated). CONCLUSION: Complete compartmental surgery without tumor rupture should be performed when possible to achieved clear margins. Wide resection lowers the local recurrence and improves survival rate. Both the state of surgical margin and grade of tumor are the most important prognostic factors which determine the survival rate and recurrence tumor.
Keywords
retroperitoneal soft tissue sarcoma; compartmental resection

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