Aggressive surgery in retroperitoneal soft tissue sarcoma carried out at high-volume centers is safe and is associated with improved local control

Background. We sought to assess morbidity and mortality in primary retroperitoneal soft tissue sarcomas (RSTS) treated by a frontline aggressive surgical approach. Methods. A total of 249 consecutive patients with primary RSTS were treated by a frontline aggressive surgical approach at two major European institutions. Multivariable models were used for exploring the relationship between postsurgical morbidity and the number of organs resected, with adjustment for clinical variables. The impact of morbidity on local and distant recurrence-free survival was explored by multivariable models, adjusting for the main known prognostic factors. Results. Median follow-up was 37 months (interquartile [IQ] range, 16-61 months). Median tumor size was 17 cm (IQ range, 11-26 cm). The median number of organs resected en bloc with the tumor was 2 (IQ range, 1-3). Complete macroscopic resection was achieved in 232 cases (93%). At 5 years, overall survival was 65.4% (95% confidence interval [95% CI], 56.8-72.7); local and distant recurrence crude cumulative incidences were 22.3% (95% CI, 16.5-30.2) and 24.2% (95% CI, 18.4-31.9), respectively. Postsurgical morbidity requiring at least one invasive therapeutic procedure was observed in 45 patients (18%; 95% CI, 14-23). Surgical reintervention was necessary in 30 patients (12%; 95% CI, 8-17). Eight patients died of postoperative complications (3%; 95% CI, 1-6). No statistically significant association between postsurgical morbidity and any clinical variable was detected. For number of resected organs, we documented an increased risk of morbidity for more than three organs (P = 0.007). Postsurgical morbidity did not affect oncologic outcome. Conclusions. Frontline aggressive surgical approach to primary RSTS is safe when carried out at high-volume centers. It could be systematically considered in primary RSTS.