Pancreaticoduodenectomy in the surgical management of primary retroperitoneal sarcoma

William W. Tseng, Denice D. Tsao-Wei, Dario Callegaro, Giovanni Grignani, Lorenzo D'Ambrosio, Sylvie Bonvalot, Cecilia G. Ethun, Kenneth Cardona, John T. Mullen, Robert J Canter, John E. Mullinax, Ricardo J. Gonzalez, Frits van Coevorden, Markus Albertsmeier, Kiran K. Dhanireddy, Salvatore L. Renne, Alessandro Gronchi

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: In retroperitoneal sarcoma (RPS), the optimal extent of resection must balance adequate disease control with potential for morbidity. We sought to study the frequency and outcomes after a Whipple procedure or pancreaticoduodenectomy (PD) in patients undergoing resection for primary RPS. Methods: Participating referral centers within the Trans-Atlantic Retroperitoneal Sarcoma Working Group provided retrospective data from January 2007 to December 2016 for patients with primary RPS who underwent PD along with the total number of consecutive resections done during the same time period. Data from participating centers were combined for analysis. Results: In total, 29 patients underwent PD among 2068 resections performed for primary RPS (1.4%). The predominant histologic subtypes were liposarcoma and leiomyosarcoma. All PD patients underwent concomitant resection of additional organs (median: 2, range: 1-5), including 13 patients (45%) who also received vena cava resection. Definitive evidence of microscopic invasion of the duodenum or pancreas was seen in 84% of patients. Postoperatively, 10 patients (34%) had major complications including 8 (28%) that developed a clinically-significant pancreatic leak. One postoperative death (3.4%) occurred. With a median follow-up of 4.8 years, 19 patients (66%) developed disease recurrence. The patterns of recurrence were dependent on histologic subtype. Conclusion: Although infrequent, when PD is done for primary RPS, resection of additional organs is often required and major complication rates are moderate. The recurrence rate is overall high and the pattern of recurrence is dictated by histologic subtype.

Original languageEnglish (US)
JournalEuropean Journal of Surgical Oncology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Pancreaticoduodenectomy
Sarcoma
Recurrence
Liposarcoma
Venae Cavae
Leiomyosarcoma
Duodenum
Pancreas
Referral and Consultation
Outcome Assessment (Health Care)
Morbidity

Keywords

  • Leiomyosarcoma
  • Liposarcoma
  • Pancreaticoduodenectomy
  • Retroperitoneal sarcoma

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Tseng, W. W., Tsao-Wei, D. D., Callegaro, D., Grignani, G., D'Ambrosio, L., Bonvalot, S., ... Gronchi, A. (Accepted/In press). Pancreaticoduodenectomy in the surgical management of primary retroperitoneal sarcoma. European Journal of Surgical Oncology. https://doi.org/10.1016/j.ejso.2018.01.086

Pancreaticoduodenectomy in the surgical management of primary retroperitoneal sarcoma. / Tseng, William W.; Tsao-Wei, Denice D.; Callegaro, Dario; Grignani, Giovanni; D'Ambrosio, Lorenzo; Bonvalot, Sylvie; Ethun, Cecilia G.; Cardona, Kenneth; Mullen, John T.; Canter, Robert J; Mullinax, John E.; Gonzalez, Ricardo J.; van Coevorden, Frits; Albertsmeier, Markus; Dhanireddy, Kiran K.; Renne, Salvatore L.; Gronchi, Alessandro.

In: European Journal of Surgical Oncology, 01.01.2018.

Research output: Contribution to journalArticle

Tseng, WW, Tsao-Wei, DD, Callegaro, D, Grignani, G, D'Ambrosio, L, Bonvalot, S, Ethun, CG, Cardona, K, Mullen, JT, Canter, RJ, Mullinax, JE, Gonzalez, RJ, van Coevorden, F, Albertsmeier, M, Dhanireddy, KK, Renne, SL & Gronchi, A 2018, 'Pancreaticoduodenectomy in the surgical management of primary retroperitoneal sarcoma', European Journal of Surgical Oncology. https://doi.org/10.1016/j.ejso.2018.01.086
Tseng, William W. ; Tsao-Wei, Denice D. ; Callegaro, Dario ; Grignani, Giovanni ; D'Ambrosio, Lorenzo ; Bonvalot, Sylvie ; Ethun, Cecilia G. ; Cardona, Kenneth ; Mullen, John T. ; Canter, Robert J ; Mullinax, John E. ; Gonzalez, Ricardo J. ; van Coevorden, Frits ; Albertsmeier, Markus ; Dhanireddy, Kiran K. ; Renne, Salvatore L. ; Gronchi, Alessandro. / Pancreaticoduodenectomy in the surgical management of primary retroperitoneal sarcoma. In: European Journal of Surgical Oncology. 2018.
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abstract = "Background: In retroperitoneal sarcoma (RPS), the optimal extent of resection must balance adequate disease control with potential for morbidity. We sought to study the frequency and outcomes after a Whipple procedure or pancreaticoduodenectomy (PD) in patients undergoing resection for primary RPS. Methods: Participating referral centers within the Trans-Atlantic Retroperitoneal Sarcoma Working Group provided retrospective data from January 2007 to December 2016 for patients with primary RPS who underwent PD along with the total number of consecutive resections done during the same time period. Data from participating centers were combined for analysis. Results: In total, 29 patients underwent PD among 2068 resections performed for primary RPS (1.4{\%}). The predominant histologic subtypes were liposarcoma and leiomyosarcoma. All PD patients underwent concomitant resection of additional organs (median: 2, range: 1-5), including 13 patients (45{\%}) who also received vena cava resection. Definitive evidence of microscopic invasion of the duodenum or pancreas was seen in 84{\%} of patients. Postoperatively, 10 patients (34{\%}) had major complications including 8 (28{\%}) that developed a clinically-significant pancreatic leak. One postoperative death (3.4{\%}) occurred. With a median follow-up of 4.8 years, 19 patients (66{\%}) developed disease recurrence. The patterns of recurrence were dependent on histologic subtype. Conclusion: Although infrequent, when PD is done for primary RPS, resection of additional organs is often required and major complication rates are moderate. The recurrence rate is overall high and the pattern of recurrence is dictated by histologic subtype.",
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AU - Tseng, William W.

AU - Tsao-Wei, Denice D.

AU - Callegaro, Dario

AU - Grignani, Giovanni

AU - D'Ambrosio, Lorenzo

AU - Bonvalot, Sylvie

AU - Ethun, Cecilia G.

AU - Cardona, Kenneth

AU - Mullen, John T.

AU - Canter, Robert J

AU - Mullinax, John E.

AU - Gonzalez, Ricardo J.

AU - van Coevorden, Frits

AU - Albertsmeier, Markus

AU - Dhanireddy, Kiran K.

AU - Renne, Salvatore L.

AU - Gronchi, Alessandro

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N2 - Background: In retroperitoneal sarcoma (RPS), the optimal extent of resection must balance adequate disease control with potential for morbidity. We sought to study the frequency and outcomes after a Whipple procedure or pancreaticoduodenectomy (PD) in patients undergoing resection for primary RPS. Methods: Participating referral centers within the Trans-Atlantic Retroperitoneal Sarcoma Working Group provided retrospective data from January 2007 to December 2016 for patients with primary RPS who underwent PD along with the total number of consecutive resections done during the same time period. Data from participating centers were combined for analysis. Results: In total, 29 patients underwent PD among 2068 resections performed for primary RPS (1.4%). The predominant histologic subtypes were liposarcoma and leiomyosarcoma. All PD patients underwent concomitant resection of additional organs (median: 2, range: 1-5), including 13 patients (45%) who also received vena cava resection. Definitive evidence of microscopic invasion of the duodenum or pancreas was seen in 84% of patients. Postoperatively, 10 patients (34%) had major complications including 8 (28%) that developed a clinically-significant pancreatic leak. One postoperative death (3.4%) occurred. With a median follow-up of 4.8 years, 19 patients (66%) developed disease recurrence. The patterns of recurrence were dependent on histologic subtype. Conclusion: Although infrequent, when PD is done for primary RPS, resection of additional organs is often required and major complication rates are moderate. The recurrence rate is overall high and the pattern of recurrence is dictated by histologic subtype.

AB - Background: In retroperitoneal sarcoma (RPS), the optimal extent of resection must balance adequate disease control with potential for morbidity. We sought to study the frequency and outcomes after a Whipple procedure or pancreaticoduodenectomy (PD) in patients undergoing resection for primary RPS. Methods: Participating referral centers within the Trans-Atlantic Retroperitoneal Sarcoma Working Group provided retrospective data from January 2007 to December 2016 for patients with primary RPS who underwent PD along with the total number of consecutive resections done during the same time period. Data from participating centers were combined for analysis. Results: In total, 29 patients underwent PD among 2068 resections performed for primary RPS (1.4%). The predominant histologic subtypes were liposarcoma and leiomyosarcoma. All PD patients underwent concomitant resection of additional organs (median: 2, range: 1-5), including 13 patients (45%) who also received vena cava resection. Definitive evidence of microscopic invasion of the duodenum or pancreas was seen in 84% of patients. Postoperatively, 10 patients (34%) had major complications including 8 (28%) that developed a clinically-significant pancreatic leak. One postoperative death (3.4%) occurred. With a median follow-up of 4.8 years, 19 patients (66%) developed disease recurrence. The patterns of recurrence were dependent on histologic subtype. Conclusion: Although infrequent, when PD is done for primary RPS, resection of additional organs is often required and major complication rates are moderate. The recurrence rate is overall high and the pattern of recurrence is dictated by histologic subtype.

KW - Leiomyosarcoma

KW - Liposarcoma

KW - Pancreaticoduodenectomy

KW - Retroperitoneal sarcoma

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