Contraindication to surgery in primary retroperitoneal sarcoma: Retrospective series on 20 years of practice in a high-volume sarcoma center

Introduction: Surgery is the cornerstone treatment for retroperitoneal sarcomas (RPS). However, contraindications for unresectability are not well-documented in the literature. Aim of the study: This study aims to identify contraindications that prevent surgery for primary RPS in a high-volume sarcoma center. Methods: We retrospectively analyzed all consecutive patients treated for primary RPS at our center from 1995 to 2021. Results: Among the 452 patients treated for primary RPS, 92 (20%) were not offered surgery. The reasons for unresectability were categorized as follows: poor general health or severe comorbidities in 39 patients (42%), preoperative detection of distant metastases in 33 patients (36%), and locally advanced disease in 20 patients (22%). Locally advanced disease included vascular involvement in 14 patients (15%) and vertebral invasion in 6 patients (7%). Among the non-operated patients, 66% received chemotherapy, 16% received radiotherapy, and 5% received combined treatments. The median progression-free survival was 7 months, and the median overall survival was 18 months. The 1-year overall survival rate was 53%. Conclusion: Contraindications for surgery in patients with primary RPS in a high-volume sarcoma center are not uncommon. The next step should be to differentiate absolute from relative (i.e., preoperative modifiable factors) contraindications.