Key clinical point: After a Whipple procedure or pancreaticoduodenectomy in patients undergoing resection for primary retroperitoneal sarcoma, resection of additional organs is often required and major complication rates are moderate. Overall, the recurrence rate is high and the pattern of recurrence is dictated by histologic subtype. A prospective study comparing pancreaticoduodenectomy to pancreaticoduodenectomy-sparing resection is needed

Main finding: Among 2068 resections performed for primary retroperitoneal sarcoma, 29 patients underwent pancreaticoduodenectomy with concomitant resection of additional organs (median: 2, range: 1–5), including 13 patients (45%) who also received vena cava resection. Postoperatively, 10 patients (34%) had major complications including 8 (28%) who developed a clinically-significant pancreatic leak. One postoperative death (3.4%) occurred. With a median follow-up of 4.8 years, 19 patients (66%) developed disease recurrence. Dedifferentiated liposarcoma recurred both locally and at distant sites, while leiomyosarcoma recurred exclusively at distant sites. For leiomyosarcomas, aggressive resection may be indicated to provide definitive local control. These patients should ideally also receive chemotherapy either in the neoadjuvant or adjuvant setting for systemic control.

Study details: Data were aggregated for the last decade regarding all patients with primary retroperitoneal sarcoma who underwent surgery within the Trans-Atlantic Retroperitoneal Sarcoma Working Group.

Disclosures: The authors have no conflicts of interest to declare.

Source: Tseng W et al. European Journal of Surgical Oncology 2018 (44): June; 810-815.