PDF(Pubmed)
Abstract：
UNASSIGNED: Retroperitoneal sarcoma (RPS) is a rare disease often requiring multi-visceral and wide margin resections for which a resection in a sarcoma center is advised. Midline incision seems to be the access of choice. However, up to now there is no evidence for the best surgical access. This study aimed to analyze the oncological outcome according to the surgical expertise and also the incision used for the resection.
UNASSIGNED: All patients treated for RPS between 2007 and 2018 at the Department of Visceral Surgery and Medicine of the University Hospital Bern and receiving a RPS resection in curative intent were included. Patient- and treatment specific factors as well as local recurrence-free, disease-free and overall survival were analyzed in correlation to the hospital type where the resection occurred.
UNASSIGNED: Thirty-five patients were treated for RPS at our center. The majority received their primary RPS resection at a sarcoma center (SC = 23) the rest of the resection were performed in a non-sarcoma center (non-SC = 12). Median tumor size was 24 cm. Resections were performed via a midline laparotomy (ML = 31) or flank incision (FI = 4). All patients with a primary FI (n = 4) were operated in a non-SC (p = 0.003). No patient operated at a non-SC received a multivisceral resection (p = 0.004). Incomplete resection (R2) was observed more often when resection was done in a non-SC (p = 0.013). Resection at a non-SC was significantly associated with worse recurrence-free survival and disease-free survival after R0/1 resection (2 vs 17 months; Log Rank p-value = 0.02 respectively 2 vs 15 months; Log Rank p-value < 0.001).
UNASSIGNED: Resection at a non-SC is associated with more incomplete resection and worse outcome in RPS surgery. Inadequate access, such as FI, may prevent complete resection and multivisceral resection if indicated and demonstrates the importance of surgical expertise in the outcome of RPS resection.
UNASSIGNED: All patients treated for RPS between 2007 and 2018 at the Department of Visceral Surgery and Medicine of the University Hospital Bern and receiving a RPS resection in curative intent were included. Patient- and treatment specific factors as well as local recurrence-free, disease-free and overall survival were analyzed in correlation to the hospital type where the resection occurred.
UNASSIGNED: Thirty-five patients were treated for RPS at our center. The majority received their primary RPS resection at a sarcoma center (SC = 23) the rest of the resection were performed in a non-sarcoma center (non-SC = 12). Median tumor size was 24 cm. Resections were performed via a midline laparotomy (ML = 31) or flank incision (FI = 4). All patients with a primary FI (n = 4) were operated in a non-SC (p = 0.003). No patient operated at a non-SC received a multivisceral resection (p = 0.004). Incomplete resection (R2) was observed more often when resection was done in a non-SC (p = 0.013). Resection at a non-SC was significantly associated with worse recurrence-free survival and disease-free survival after R0/1 resection (2 vs 17 months; Log Rank p-value = 0.02 respectively 2 vs 15 months; Log Rank p-value < 0.001).
UNASSIGNED: Resection at a non-SC is associated with more incomplete resection and worse outcome in RPS surgery. Inadequate access, such as FI, may prevent complete resection and multivisceral resection if indicated and demonstrates the importance of surgical expertise in the outcome of RPS resection.
摘要：
■腹膜后肉瘤（RPS）是一种罕见的疾病，通常需要进行多内脏和宽切缘切除，建议在肉瘤中心进行切除。中线切口似乎是首选。然而,到目前为止，还没有证据表明最好的手术途径。本研究旨在根据手术专业知识以及用于切除的切口分析肿瘤的结果。
■包括2007年至2018年在伯尔尼大学医院内脏外科和医学部接受RPS治疗并接受治愈性RPS切除术的所有患者。患者和治疗的特定因素以及无局部复发，我们分析了无病生存期和总生存期与发生切除的医院类型的相关性.
■35例患者在我们中心接受了RPS治疗。大多数人在肉瘤中心（SC=23）接受了原发性RPS切除术，其余切除术在非肉瘤中心（非SC=12）进行。中位肿瘤大小为24cm。通过中线剖腹手术（ML=31）或侧腹切口（FI=4）进行切除。所有原发性FI（n=4）的患者均在非SC中进行手术（p=0.003）。没有在非SC手术的患者接受多内脏切除术（p=0.004）。当在非SC中进行切除时，更经常观察到不完全切除（R2）（p=0.013）。R0/1切除后，非SC切除与无复发生存率和无疾病生存率显着相关（2vs17个月；LogRankp值分别为0.02和2vs15个月；LogRankp值<0.001）。
■在RPS手术中，非SC切除与更不完整的切除和更差的结果相关。访问不足，如FI，如果有必要,可能会阻止完全切除和多内脏切除,并证明手术专业知识在RPS切除结果中的重要性.
■包括2007年至2018年在伯尔尼大学医院内脏外科和医学部接受RPS治疗并接受治愈性RPS切除术的所有患者。患者和治疗的特定因素以及无局部复发，我们分析了无病生存期和总生存期与发生切除的医院类型的相关性.
■35例患者在我们中心接受了RPS治疗。大多数人在肉瘤中心（SC=23）接受了原发性RPS切除术，其余切除术在非肉瘤中心（非SC=12）进行。中位肿瘤大小为24cm。通过中线剖腹手术（ML=31）或侧腹切口（FI=4）进行切除。所有原发性FI（n=4）的患者均在非SC中进行手术（p=0.003）。没有在非SC手术的患者接受多内脏切除术（p=0.004）。当在非SC中进行切除时，更经常观察到不完全切除（R2）（p=0.013）。R0/1切除后，非SC切除与无复发生存率和无疾病生存率显着相关（2vs17个月；LogRankp值分别为0.02和2vs15个月；LogRankp值<0.001）。
■在RPS手术中，非SC切除与更不完整的切除和更差的结果相关。访问不足，如FI，如果有必要,可能会阻止完全切除和多内脏切除,并证明手术专业知识在RPS切除结果中的重要性.
