NEPHRECTOMY DURING OPERATIVE MANAGEMENT OF RETROPERITONEAL SARCOMA

Background: Complete resection of a retroperitoneal sarcoma often requ ires removal of adjacent organs. In this study we evaluated the role o f nephrectomy during operation for retroperitoneal sarcoma. Methods: B etween July 1982 and July 1995, 75 of the 371 (20%) patients who under went resection of retroperitoneal sarcoma at MSKCC underwent concommit ant nephrectomy. Data concerning the reasons for nephrectomy, degree o f sarcomatous renal involvement, and survival were retrospectively ana lyzed. Results: Fifty-four patients (72%) underwent nephrectomy during the initial resection, and 21 (28%) during a resection of a recurrent or persistent tumor. The most common reason for nephrec tomy was tota l encasement by sarcoma (n = 40; 53%), followed by dense adherence of the tumor to the kidney (n = 21; 28%), and the direct invasion of the kidney by tumor (n = 2; 3%). Pathology demonstrated an absence of kidn ey invasion in the majority of cases (55 of 75; 73%). Renal capsular i nvasion was present in 11 of 75 (15%), renal parenchymal invasion in 7 of 75 (9%), and renal vein invasion in 2 of 75 (3%) of cases. There w ere no significant differences in survival based on degree of sarcoma involvement of the kidney, tumor grade, or whether the resection was f or primary or recurrent disease. The 53 patients who underwent a compl ete gross resection of all tumor had a significantly improved long-ter m survival compared to the 20 patients who did not (50% versus 20% DFS at 5 years, respectively; p < 0.001). Conclusions: Decisions for conc omitant nephrectomy during resection of retroperitoneal sarcoma should be based on whether this maneuver will provide a complete resection o f all gross tumor, in which case the long-term disease-free survival o f 50% is comparable to the reported 5-year survival of all patients wi th retroperitoneal sarcoma who are completely resected.