Contraindication to surgery in primary retroperitoneal sarcoma: Retrospective series on 20years 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 7months, and the median overall survival was 18months. 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.