HIGH-GRADE RETROPERITONEAL SARCOMAS - ROLE OF AN AGGRESSIVE PALLIATIVE APPROACH

Between 1968 and 1988 we treated 41 patients with high-grade soft tiss ue retroperitoneal sarcomas. Clinical, pathological, and treatment var iables were analyzed retrospectively with regard to their influence on recurrence rate and mortality. The actuarial 5-year median survival f or the whole group was 48 months, with 33% of the patients surviving 1 0 years. Gender, clinical presentation, tumor size, and histological t ypes did not predict outcome by multivariate analysis. Complete tumor resection was performed in 56% of the patients, but at 10 years after surgery only 10% of those patients remained disease free. Patients wer e classified into four groups according to the most aggressive surgica l procedure employed: (1) total gross tumor resection; (2) subtotal re section, in which the major tumor bulk was excised (often with adjacen t organs), but in which obvious residual disease remained; (3) palliat ive resection, in which minimal tumor resection was performed in order to alleviate symptoms; and (4) exploration only. Patients who were ei ther explored and had no tumor removed or who underwent a palliative r esection had a similarly poor prognosis, with a median survival of 12 and 20 months, respectively. To our surprise, patients after total res ection had no survival benefit over patients who had undergone subtota l resection. However, both groups together had a significantly longer median survival of 241 months compared to the median survival of the p atients with either no resection or only palliative resection (P < 0.0 2). The addition of chemotherapy or radiation therapy failed to show a ny advantage in this series. We claim from our experience that the imp ossibility of performing a complete resection should not prevent attem pts at aggressive subtotal tumor excision, including the removal of ad jacent organs, since this aggressive surgical approach may prolong sur vival significantly. (C) 1993 Wiley-Liss, Inc.