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Published in: Annals of Surgical Oncology 4/2011

01-04-2011 | Bone and Soft Tissue Sarcomas

Surgical Approach and Oncologic Outcomes Following Multidisciplinary Management of Retrorectal Sarcomas

Authors: Eric J. Dozois, MD, David J. Jacofsky, MD, Brian J. Billings, MD, Antonio Privitera, MD, PhD, Robert R. Cima, MD, Peter S. Rose, MD, Franklin H. Sim, MD, Scott H. Okuno, MD, Michael G. Haddock, MD, William S. Harmsen, MS, Carrie Y. Inwards, MD, David W. Larson, MD

Published in: Annals of Surgical Oncology | Issue 4/2011

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Abstract

Background

Retrorectal sarcomas are rare, and limited data are available on oncologic outcomes following surgery. Our aim was to evaluate outcomes in this patient population at our institution.

Materials and Methods

All patients who underwent surgical resection of a malignant retrorectal/presacral sarcoma between 1985 and 2005 were identified. Data analyzed included demographics, histopathologic diagnosis, surgical morbidity and mortality, use of adjuvant therapy, local and distant recurrence, and survival.

Results

A total of 37 patients were identified (20 males) with a median age of 49 years (range, 22–81 years). The most common histopathologic diagnosis was malignant peripheral nerve sheath tumor (n = 8). Also, 22 tumors were high grade and 15 were low grade. Surgical margin status was R0 in 31 patients and R1 in 6. Adjuvant therapy was given to 26 patients. Postoperative morbidity and mortality was 57% and 3%, respectively. Median length of follow-up in 16 patients alive at last contact was 4.7 years. The 5-year survival free of local (LDFS), distant (DDFS), and local or distant recurrence (DFS) was 51, 58, and 39%, respectively. Patient survival at 2, 5, and 10 years was 75, 55, and 47%, respectively. Disease-free survival was not significantly associated with gender (P = .16), primary vs secondary (P = .94), R0 vs R1 resection (P = .26), low vs high tumor grade (P = .17), or the use of surgery with or without adjuvant therapy (P = .33).

Conclusions

Retrorectal sarcomas are often high grade and locally advanced. Most tumors are resectable with free margins, and long-term survival may be possible in up to one-half of patients following an aggressive surgical approach.
Literature
1.
go back to reference Cody HS 3rd, Marcove RC, Quan SH. Malignant retrorectal tumors: 28 years’ experience at Memorial Sloan-Kettering Cancer Center. Dis Colon Rectum. 1981;24:501–6.PubMedCrossRef Cody HS 3rd, Marcove RC, Quan SH. Malignant retrorectal tumors: 28 years’ experience at Memorial Sloan-Kettering Cancer Center. Dis Colon Rectum. 1981;24:501–6.PubMedCrossRef
2.
go back to reference Gray SW, Singhabhandhu B, Smith RA, Skandalakis JE. Sacrococcygeal chordoma: report of a case and review of the literature. Surgery. 1975;78:573–82.PubMed Gray SW, Singhabhandhu B, Smith RA, Skandalakis JE. Sacrococcygeal chordoma: report of a case and review of the literature. Surgery. 1975;78:573–82.PubMed
3.
go back to reference Jao SW, Beart RW Jr, Spencer RJ, Reiman HM, Ilstrup DM. Retrorectal tumors: Mayo Clinic experience, 1960–1979. Dis Colon Rectum. 1985;28:644–52.PubMedCrossRef Jao SW, Beart RW Jr, Spencer RJ, Reiman HM, Ilstrup DM. Retrorectal tumors: Mayo Clinic experience, 1960–1979. Dis Colon Rectum. 1985;28:644–52.PubMedCrossRef
4.
go back to reference Fuchs B, Dickey ID, Yaszemski MJ, Inwards CY, Sim FH. Operative management of sacral chordoma. J Bone Joint Surg. 2005;87:2211–6.PubMedCrossRef Fuchs B, Dickey ID, Yaszemski MJ, Inwards CY, Sim FH. Operative management of sacral chordoma. J Bone Joint Surg. 2005;87:2211–6.PubMedCrossRef
5.
go back to reference Jackman RJ, Clark PL III, Smith ND. Retrorectal tumors. JAMA. 1951;145:956–62. Jackman RJ, Clark PL III, Smith ND. Retrorectal tumors. JAMA. 1951;145:956–62.
7.
go back to reference Wang JY, Hsu CH, Changchien CR, Chen JS, Hsu KC, You YT, et al. Presacral tumor: a review of forty-five cases. Am Surg. 1995;61:310–5.PubMed Wang JY, Hsu CH, Changchien CR, Chen JS, Hsu KC, You YT, et al. Presacral tumor: a review of forty-five cases. Am Surg. 1995;61:310–5.PubMed
8.
go back to reference Herr HW. Sarcomas of the urinary tract. In: de Kernion JB, Paulson DF, editors. Genitourinary Cancer Management. Philadelphia, PA: Lea & Febiger; 1987. p. 259–70. Herr HW. Sarcomas of the urinary tract. In: de Kernion JB, Paulson DF, editors. Genitourinary Cancer Management. Philadelphia, PA: Lea & Febiger; 1987. p. 259–70.
9.
go back to reference Russo P, Brady MS, Conlon K, Hajdu SI, Fair WR, Herr HW, et al. Adult urological sarcoma. J Urol. 1992;47:1032–7. Russo P, Brady MS, Conlon K, Hajdu SI, Fair WR, Herr HW, et al. Adult urological sarcoma. J Urol. 1992;47:1032–7.
10.
go back to reference Mackenzie S, Reid R, Barrett A, O’Dwyer PJ. Management of soft tissue sarcomas of the abdomen and pelvis. Colorectal Dis. 2003;5:129–32.PubMedCrossRef Mackenzie S, Reid R, Barrett A, O’Dwyer PJ. Management of soft tissue sarcomas of the abdomen and pelvis. Colorectal Dis. 2003;5:129–32.PubMedCrossRef
11.
go back to reference Keyzer-Dekker CM, Houtkamp RG, Peterse JL, van Coevorden F. Adult pelvic sarcomas: a heterogeneous collection of sarcomas. Sarcoma. 2004;8:19–24.PubMedCrossRef Keyzer-Dekker CM, Houtkamp RG, Peterse JL, van Coevorden F. Adult pelvic sarcomas: a heterogeneous collection of sarcomas. Sarcoma. 2004;8:19–24.PubMedCrossRef
12.
go back to reference Lewis JJ, Leung D, Woodruff JM, Brennan MF. Retroperitoneal soft-tissue sarcoma. Analysis of 500 patients treated and followed at a singe institution. Ann Surg. 1998;228:355–65.PubMedCrossRef Lewis JJ, Leung D, Woodruff JM, Brennan MF. Retroperitoneal soft-tissue sarcoma. Analysis of 500 patients treated and followed at a singe institution. Ann Surg. 1998;228:355–65.PubMedCrossRef
13.
go back to reference Karakousis CP, Kontzoglou K, Driscoll DL. Resectability of retroperitoneal sarcomas; a matter of surgical technique? Eur J Surg Oncol. 1995;21:617–22.PubMedCrossRef Karakousis CP, Kontzoglou K, Driscoll DL. Resectability of retroperitoneal sarcomas; a matter of surgical technique? Eur J Surg Oncol. 1995;21:617–22.PubMedCrossRef
14.
go back to reference Zhang G, Chen KK, Manivel C, Fraley EE. Sarcomas of the retroperitoneum and genitourinary tract. J Urol. 1989;141:1107–10.PubMed Zhang G, Chen KK, Manivel C, Fraley EE. Sarcomas of the retroperitoneum and genitourinary tract. J Urol. 1989;141:1107–10.PubMed
15.
go back to reference Raut CP, Pisters PW. Retroperitoneal sarcomas: combined-modality treatment approaches. J Surg Oncol. 2006;94:81–7.PubMedCrossRef Raut CP, Pisters PW. Retroperitoneal sarcomas: combined-modality treatment approaches. J Surg Oncol. 2006;94:81–7.PubMedCrossRef
16.
go back to reference Yang J, Chang A, Baker A, Sindelar WF, Danforth DN, Topalian SL, et al. Randomized prospective study of benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16:197–203.PubMed Yang J, Chang A, Baker A, Sindelar WF, Danforth DN, Topalian SL, et al. Randomized prospective study of benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol. 1998;16:197–203.PubMed
17.
go back to reference Feng M, Murphy J, Griffith KA. Long-term outcomes after radiotherapy for retroperitoneal and deep truncal sarcoma. Int J Radiat Oncol Biol Phys. 2007;69:103–10.PubMedCrossRef Feng M, Murphy J, Griffith KA. Long-term outcomes after radiotherapy for retroperitoneal and deep truncal sarcoma. Int J Radiat Oncol Biol Phys. 2007;69:103–10.PubMedCrossRef
18.
go back to reference Rosenberg S, Tepper J, Glatstein E, Costa J, Baker A, Brennan M, et al. The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluation of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant therapy. Ann Surg. 1982;196:305–15.PubMedCrossRef Rosenberg S, Tepper J, Glatstein E, Costa J, Baker A, Brennan M, et al. The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluation of (1) limb-sparing surgery plus radiation therapy compared with amputation and (2) the role of adjuvant therapy. Ann Surg. 1982;196:305–15.PubMedCrossRef
19.
go back to reference Tierney J, Stewart L, Parmar M, et al. Adjuvant chemotherapy for localized resectable soft-tissue sarcoma of adult: meta-analysis of individual data. Lancet. 1997;350:1647–54.CrossRef Tierney J, Stewart L, Parmar M, et al. Adjuvant chemotherapy for localized resectable soft-tissue sarcoma of adult: meta-analysis of individual data. Lancet. 1997;350:1647–54.CrossRef
20.
go back to reference Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC Cancer Staging Manual. 7th ed. New York: Springer; 2010. p. 291. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC Cancer Staging Manual. 7th ed. New York: Springer; 2010. p. 291.
Metadata
Title
Surgical Approach and Oncologic Outcomes Following Multidisciplinary Management of Retrorectal Sarcomas
Authors
Eric J. Dozois, MD
David J. Jacofsky, MD
Brian J. Billings, MD
Antonio Privitera, MD, PhD
Robert R. Cima, MD
Peter S. Rose, MD
Franklin H. Sim, MD
Scott H. Okuno, MD
Michael G. Haddock, MD
William S. Harmsen, MS
Carrie Y. Inwards, MD
David W. Larson, MD
Publication date
01-04-2011
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 4/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-010-1445-x

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