Outcomes of palliative-intent surgery in retroperitoneal sarcoma—Results from the US Sarcoma Collaborative

Background and Objectives: Outcomes of palliative-intent surgery in retroperitoneal sarcomas (RPS) are not well understood. This study aims to define indications for and outcomes after palliative-intent RPS resection. Methods: Using a retrospective 8-institution database, patients undergoing resection of primary/recurrent RPS with palliative intent were identified. Logistic regression and Cox-proportional hazards models were constructed to analyze factors associated with postoperative complications and overall survival (OS). Results: Of 3088 patients, 70 underwent 87 palliative-intent procedures. Most common indications were pain (26%) and bowel obstruction (21%). Dedifferentiated liposarcoma (n = 17, 24%), leiomyosarcoma (n = 13, 19%) were predominant subtypes. Median OS was 10.69 months (IQR, 3.91-23.23). R2 resection (OR, 8.60; CI, 1.42-52.15; P =.019), larger tumors (OR, 10.87; CI, 1.44-82.11; P =.021) and low preoperative albumin (OR, 0.14; CI, 0.04-0.57; P =.006) were associated with postoperative complications. Postoperative complications (HR, 1.95; CI, 1.02-3.71; P =.043) and high-grade histology (HR, 6.56; CI, 1.72-25.05; P =.006) rather than resection status were associated with reduced OS. However, in R2-resected patients, development of postoperative complications significantly reduced survival (P =.042). Conclusions: Postoperative complications and high-grade histology rather than resection status impacts survival in palliative-intent RPS resections. Given the higher incidence of postoperative complications which may diminish survival, palliative-intent R2 resection should be offered only after cautious consideration.