The role of multivisceral resection on outcomes in primary retroperitoneal sarcoma: A systematic review by the Australian and New Zealand Sarcoma Association Clinical Practice Guidelines Working Party

Background Retroperitoneal sarcoma (RPS) has high local recurrence rates and poor outcomes, with complete surgical resection being the only curative treatment. Over the past two decades, there has been a trend towards multivisceral resection (MVR). This systematic review sought to evaluate the role of MVR compared with simple resection in patients with primary RPS. Methods A systematic review was conducted following PICO methodology. Adult patients with primary localized RPS undergoing MVR were compared to those receiving simple resection. Primary outcomes included abdominal recurrence-free survival, overall survival, and perioperative morbidity. Results Twenty-three retrospective studies were identified, with patient cohorts ranging from 23 to 1007 participants. Results demonstrated conflicting evidence regarding MVR's impact on survival outcomes. The highest quality study showed MVR significantly reduced 3-year abdominal recurrence rates (10% vs 47%, HR 1.99, p=0.04) compared to simple resection. However, MVR did not significantly improve overall survival across most studies. Analysis of perioperative morbidity consistently demonstrated that MVR does not significantly increase complications compared to simple resection. Conclusions Current evidence suggests MVR may reduce abdominal recurrence in primary RPS without significantly increasing perioperative morbidity, though overall survival benefits remain unproven. MVR could be considered for RPS subtypes at high risk of local recurrence, particularly liposarcoma, to maximize local control without significantly increasing perioperative morbidity. Given that complete surgical resection remains the only curative therapy for RPS, the decision for MVR should be individualized with input from a sarcoma multidisciplinary team.