Surgery for retroperitoneal sarcoma in the elderly


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Henry Smith1,Joseph Meirion Thomas1,Myles Smith1,Andrew Hayes1,Dirk Strauss1
1The Royal Marsden Hospital

Abstract

Background

Retroperitoneal sarcomas (RPS) occur in an anatomically complex location often involving several adjacent organs. Surgery with multi-visceral resection constitutes the mainstay of curative therapy. We sought to characterise the morbidity and oncological outcomes of surgery for RPS in an elderly population.

Method

Patients > 70 years old with primary, localised RPS referred between 1/1/08-31/12/14 were identified from multidisciplinary meeting records.

Results

A total of 126 patients were identified. The median age was 76 years (range 70-96), with a M:F of 0.8. The most common histological subtypes were de-differentiated liposarcoma (42.9%), well-differentiated liposarcoma (17.5%) and leiomyosarcoma (16.6%). 66 patients did not undergo surgery (52.4%). Reasons included a technically irresectable tumour (31/66, 46.9%), patient comorbidities (23/66, 34.8%), and patient choice (12/66, 18.2%). Radiotherapy only was given to 11 of these patients, with the remaining 55 receiving best supportive care. Median overall survival in patients managed non-operatively was 16 months.

Surgical resection was performed in 60 patients (47.6%). Resection was macroscopically complete in all patients. In 53 patients (88.3%), a contiguous organ was included in the resection. The 30-day mortality and morbidity were 3.3% and 30.0%, respectively. Median overall survival in patients managed operatively was 58 months. At 5 years, the local recurrence free survival was 64.8% and distant metastasis free survival was 84.9%.

Patients in the non-operative group were significantly older (median age 78 vs 74.5 years, p<0.001). Patients in the operative group had significantly larger tumours (median size 22.5 vs 17.0 cm, p<0.001). Median survival was significantly longer in the operative group (58 vs 16 months, p < 0.001).

Conclusion

Almost half of patients with primary localised RPS aged >70 years are suitable for multi-visceral resection. The prognosis for patients unsuitable for surgery is poor. Multi-visceral resection achieves durable local control but with increased rates of morbidity.