What is the clinical evidence from this study?

Study design: Cohort. Population: Retroperitoneal sarcoma (n=252). Intervention: Aggressive surgical approach with vascular resection vs. Surgical resection without vascular resection. Primary outcome: Median overall survival (months) (p=0.268).

March 20, 2025Open Access

Aggressive surgical approach with major vascular resection for retroperitoneal sarcomas

YLYiyuan LiInstitute of Archaeology JZJichun ZhaoSichuan University BHBin HuangSichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital

Key Result

In patients with retroperitoneal sarcoma and vascular involvement, an aggressive surgical approach with vascular resection significantly improved median overall survival to 66.3 months compared to 25.6 months with palliative resection.

Study Design

Type

Cohort (n=252)

Multicenter

Structured PICO

Does an aggressive surgical approach with vascular resection improve overall survival in patients with retroperitoneal sarcoma with vascular involvement?

Population

252 patients who underwent surgical resection (with or without vascular resection) for retroperitoneal sarcoma (RPS) between 2015 and 2020

Intervention

Aggressive surgical approach with vascular resection

Comparator

Palliative resection (in patients with vascular involvement) or no vascular resection

Outcome

Long-term overall survival (OS)hard clinical

In patients with retroperitoneal sarcoma and vascular involvement, an aggressive surgical approach with vascular resection significantly improves overall survival compared to palliative resection without increasing morbidity or mortality.

Main Result

Absolute Event Rate: 52.4% vs 56%

p-value: p=0.268

Limitations

Selection bias due to the retrospective nature of the study
No propensity score matching was performed
Invasion status and surgical margin status were based on intraoperative findings but not confirmed via pathology
Subjective assessment of technical resectability by the operating surgeon
Small sample size limited evaluation of other factors in subgroup analyses

Abstract

BACKGROUND: En bloc resection of adjacent structures, including major vessels, is often required to achieve negative margins in retroperitoneal sarcoma (RPS). However, the effect of vascular involvement and different reconstruction techniques in patients undergoing vascular resection remains unclear. This study investigated the morbidity, mortality, and long-term survival of patients who underwent an aggressive surgical approach with vascular resection for RPS. METHODS: We analyzed a prospectively maintained database of patients who underwent surgical resection (with or without vascular resection) for RPS between 2015 and 2020. The primary endpoint was long-term overall survival (OS). FINDINGS: The study population comprised 252 patients. Postoperative morbidity, mortality, and OS did not differ significantly between the vascular and no vascular resection groups. Among patients with vascular involvement, those who underwent aggressive surgical approach with vascular resection had a significantly higher OS (66.3 months vs. 25.6 months) compared to those who underwent palliative resection, without an increase in mortality or complication rate. No significant differences were observed in postoperative morbidity, 30-day mortality, or estimated median OS between patients who underwent primary repair and reconstruction. CONCLUSIONS: In patients with RPS with vascular involvement, an aggressive surgical approach with vascular resection achieved optimal clinical outcomes. Vascular reconstruction techniques had no impact on clinical outcomes.

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