Extended surgical resection for primary retroperitoneal sarcoma. Systematic review and meta- analysis

Background & Objectives : Retroperitoneal sarcomas are often advanced at presentation. Surgery remains the only available curative management. The extent of surgical resection is debatable. There is a strong cause for compartmental resection of the whole hemi-retroperitoneum, but high-level evidence is lacking. This systematic review examines published evidence for the effect of resection policy on the oncologic outcome. Methods : The PubMed was searched for “retroperitoneal neoplasms”, “surgery”, “surgical procedures, operative”, and “margin of resection”. Web Of Science™ was searched for “retroperitoneal neoplasms” and “surgical management”. English-language articles that investigated retroperitoneal sarcoma in adult patients with extent of surgery as an independent variable and oncologic outcome as endpoints were included. Results : Twenty-three articles were retained for analysis. All articles were retrospective. Meta-analysis showed equivalence of overall survival with extended surgery versus limited surgery and with sole tumor resection versus en-bloc resection with contiguous organs. Multivisceral resection did not increase morbidity. Conclusions : The role of universal extended surgery and the subset of patients who may benefit from irradiation treatment remain open questions.