Soft tissue sarcoma in the retroperitoneum: an often neglected diagnosis

Aims: Successful surgical treatment of patients with retroperitoneal soft t issue sarcoma (RSTS) is based on preoperative planning that starts with a c orrect pre-operative diagnosis. In a population-based study, we determined which patients were initially treated for assumed other conditions. The eff ect of an erroneous diagnosis on the installed treatment was analysed. Method: With the help of the Dutch Network and National Database for Pathol ogy (PALGA), data were collected on 143 patients in the Netherlands in whom a primary RSTS was found and confirmed histologically between I January 19 89 and 1 January 1994. Satisfactory clinical information was obtained on 13 8 patients, 64 males and 74 females (54%). The median age was 60 (range 18- 88) years. Results: At the time of actual treatment 37% of the patients with RSTS were assumed to have another disorder (group I; n=51), whereas 87 patients were diagnosed as having RSTS (group 2). In group I, an acute presentation was more common (18 vs 2%; P=0.002), and the tumour was less often palpable at physical examination (43 vs 69%; P=0.004), while clinical work-up less freq uently included CT-imaging (57 vs 89%; P<0.001) and a biopsy (29 vs 77%; P< 0.001). Although tumours in group I were smaller (median diameter 13 vs 19 cm; P<0.05), this was not reflected in a better operative result: less pati ents underwent complete tumour resection (51 vs 57%) and more patients unde rwent surgery for tumours that proved to be irresectable (14 vs 1%; P = 0.0 04). Conclusions: (1) More than one-third of patients with RSTS are misdiagnosed and inappropriately treated; and (2) biopsies and cross-sectional imaging improve diagnosis. (C) 2001 Harcourt Publishers Ltd.