Retroperitoneal liposarcomas surgical treatment: retrospective analysis of prognostic factors

Abstract

Introduction: Retroperitoneal soft tissue sarcomas have a wide range of histologic entities but they are frequently studied as a single disease. Being liposarcomas the most frequent histologic type, we’ve carried a retrospective analysis from a cohort of patients treated at a referral center to assess prognostic factors associated with demographic and therapeutic characteristics.
Methods: A retrospective analysis of a single center cohort of adult patients who underwent surgical treatment for retroperitoneal liposarcomas between 2007 and 2013 was performed.
Results: Fifty-five patients were included. Thirty-two (58%) were female. Median age was 62 years old (ranging from 19-84). Median size at diagnosis was 26.5 cm and most patients (76.4%) were symptomatic at diagnosis. Histology results were the following: 28 well differentiated liposarcomas, 11 dediferentiated liposarcomas, 9 myxoid and 7 high grade liposarcomas. Well differentiated histologies were more frequent among women and also occurred at a later age. Median follow up was 48 months and a specific disease survival (SDS) of 63% at 5 years was obtained.
Prognosis was influenced by histology, gender, tumor grade and invasion of adjacent organ. . Macroscopic complete resection had significant impact on survival with no difference observed between R0 and R1 resections. Thirty-four patients had disease recurrence and all of them were reoperated. Surgical treatment was able to treat effectively these patients since no difference was observed in SDS when comparing patients with one versus multiple surgeries. Dedifferentiation at recurrence was not associated with a worse SDS.
Conclusions: As expected, these patients present with large tumors at diagnosis. Female gender and low grade diseases were associated with a better prognosis. Regarding liposarcoma treatment, a macroscopic complete resection (with organ resection if needed) during the first surgery seems to be the most important therapeutic aspect impacting SDS. Although our results support the need for macroscopic complete resection as well as reoperations when disease recurs, new therapeutic options are needed to improve outcomes.