Management of Recurrent Retroperitoneal Sarcoma
Abstract
:1. Introduction
2. Imaging
3. Chemotherapy
4. Radiation
5. Resection
6. Patient Selection
7. Conclusions
- Recurrence is common after surgery for RPS, and pattern of recurrence (local recurrence vs. distant metastasis) varies by histology.
- Patients with primary and recurrent RPS should be referred for multidisciplinary evaluation at a sarcoma center.
- High-quality, contrast-enhanced CT imaging of the chest, abdomen, and pelvis should be performed when tumor recurrence is first identified.
- MRI may be useful to help delineate pelvic disease or extent of tumor involvement.
- Neoadjuvant therapy may have some limited utility in downsizing large or locally invasive tumors, although data are limited.
- Data on the use of adjuvant therapy and radiation are limited in the setting of recurrent disease.
- Repeat resection is worth considering for technically resectable local and distant recurrence and has an associated survival benefit.
- In general, multifocal recurrence is associated with worse survival and should be reserved for palliation in symptomatic patients.
Author Contributions
Funding
Informed Consent Statement
Conflicts of Interest
References
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Incision should maximize exposure and minimize the risk of tumor capsule disruption. |
A midline laparotomy has the benefit of adequate access to the retroperitoneum, as well as future access in the case of local recurrence. |
Chevron, Makuuchi, or thoracoabdominal incisions may provide superior exposure for upper quadrant sarcomas. |
A transverse flank or modified Gibson incision may provide superior exposure of the superior pelvis and iliac vessels, particularly for extraperitoneal pelvic sarcomas. |
While access to the retroperitoneum may involve mobilization of the colon, a macroscopically complete resection often necessitates en bloc colectomy and resection of any additional involved organs. |
Preoperative planning and sterile preparation should anticipate the possibility of an end or diverting ostomy. |
Right-sided tumors may require nephroureterectomy with Kocherization of the duodenum and head of the pancreas and include ipsilateral colectomy, adrenalectomy, and psoas/psoas fascia resection. |
Left-sided tumors may require nephroureterectomy, as well as distal pancreatectomy and splenectomy and include ipsilateral colectomy, adrenalectomy, and psoas/psoas fascia resection. |
Tumors arising from the lower 1/3 of the inferior vena cava (IVC) may require a full Cattell-Brasch maneuver for exposure. |
Tumors arising from the middle 1/3 of the IVC may require hepatic resection of uninvolved tissue for an R0 resection. |
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Jolissaint, J.S.; Raut, C.P.; Fairweather, M. Management of Recurrent Retroperitoneal Sarcoma. Curr. Oncol. 2023, 30, 2761-2769. https://doi.org/10.3390/curroncol30030209
Jolissaint JS, Raut CP, Fairweather M. Management of Recurrent Retroperitoneal Sarcoma. Current Oncology. 2023; 30(3):2761-2769. https://doi.org/10.3390/curroncol30030209
Chicago/Turabian StyleJolissaint, Joshua S., Chandrajit P. Raut, and Mark Fairweather. 2023. "Management of Recurrent Retroperitoneal Sarcoma" Current Oncology 30, no. 3: 2761-2769. https://doi.org/10.3390/curroncol30030209