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Frontline Aggressive Surgical Approach To Primary Retroperitoneal STS: A Morbidity / Mortality

Connective Tissue Oncology Society 15th Annual Meeting Miami, November 5-7th 2009. Frontline Aggressive Surgical Approach To Primary Retroperitoneal STS: A Morbidity / Mortality Analysis From A Multi-Institutional Retrospective Review. Marco Fiore marco.fiore@istitutotumori.mi.it.

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Frontline Aggressive Surgical Approach To Primary Retroperitoneal STS: A Morbidity / Mortality

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  1. Connective Tissue Oncology Society15th Annual MeetingMiami, November 5-7th 2009 Frontline Aggressive Surgical Approach To Primary Retroperitoneal STS: A Morbidity / Mortality Analysis From A Multi-Institutional Retrospective Review. Marco Fiore marco.fiore@istitutotumori.mi.it Sylvie Bonvalot sylvie.bonvalot@igr.fr

  2. Aggressive surgery associated with improved local control

  3. Liberal en-bloc visceral resections: Nephrectomy and GI major surgery (with the exception of pancreato-duodenectomy and major hepatectomy, performed only if infiltrated) Loco-regional peritonectomy and miomectomy of the psoas: To accomplish better en-bloc resection Vascular surgery and bone resection Feasible but performed only if vessels/bone infiltrated “Aggressive surgical approach” Storm, Mahvi – Ann Surg 1990

  4. Selection of cases / organs (due to expected morbidity): some but not all margins improve Data on short- and long-term morbidity not as yet provided

  5. “Aggressive surgical approach” routinely recommended ? focus on safety the formal evidence is weak (retrospective) a randomized study (it will never be done!)

  6. Median follow-up: 37 months (IQ range: 16-61) Median age: 55 years (IQ range: 45-66) Male/Female: 1/1 Median size: 17 cm (IQ range: 11-26) Lipo 57%; Leio 18%; MPNST 6%; SFT 6%; Other 13% Median post-operative stay: 13 days (IQ range: 11-16) 249 primary RSTS (2000-2008)

  7. Best 5 yr overall survival and local control ever reported OS LR - DM

  8. Previous (median) 78% 51% 57% Current Series 93% 65% 78%

  9. Median # of organ resected: 2 (IQ range: 1-3) Number of organ resected Type of organ resected

  10. Morbidity & Mortality

  11. Common Terminology Criteria for Adverse Events (CTCAE) v3.0 https://webapps.ctep.nci.nih.gov/webobjs/ctc/webhelp/welcome_to_ctcae.htm

  12. Number of organs resected > 3 correlate with higher risk of morbidity Log odds # of organs resected

  13. The organs resected correlate with the risk of morbidity OR OR Right Colon 0.74 0.74 Left Colon 1.10 1.10 Kidney Kidney 1.08 1.08 Psoas 0.70 0.70 Pancreas Pancreas 1.57 1.57 Spleen Spleen 1.48 1.48 Uterus Uterus 0.64 0.64 Ovary Ovary 0.79 0.79 Diaphragm Diaphragm 1.43 1.43 Parietal muscle Parietal muscle 1.03 1.03 Stomach Stomach 3.57 3.57 Small bowel Small bowel 2.98 2.98 Bone Bone 1.31 1.31 Nerve Nerve 0.98 0.98 Vein Vein 2.63 2.63 Artery Artery 3.57 3.57 0 0 1 1 2 2 3 3 4 4 5 5 10 10 20 20

  14. Other prognostic factors for morbidity 95% C.I. Wald test OR

  15. Morbidity Mortality 18% 3% 18% (range 9-37%) 3% (range 1-7%) 30% (range 15-50%) 3% (range 1-5%) 10% (range 3-15%) 3% (range 2-4%) 5% (range 2-8%) 3% (range 2-4%)

  16. …in brief

  17. Retroperitoneal STS are a challenging disease more for their anatomical location than for their biology Frontline approach is crucial: need for an aggressive surgery to minimize positive margins, often including adjacent uninvolved visceral organs. Safety is comparable to other major abdominal operations, if carried out at high-volume centers Need to refer these patients to high-volume centers to have the best ratio between aggressiveness and morbidity

  18. marco.fiore@istitutotumori.mi.it

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