The role of surgical access in retroperitoneal sarcoma resection - a retrospective study

Abstract Background Retroperitoneal sarcoma (RPS) is a rare disease often requiring multi-visceral and wide margin resections. Midline incision seems to be the access of choice. Up to now there is no evidence for the best surgical access. This study aimed to analyze the oncological outcome according to the incision used for the resection. Methods All patients treated for RPS between 2007 and 2018 at the Department of Visceral Surgery and Medicine of the University Hospital Bern and receiving a RPS resection in curative intent were included. Patient- and treatment specific factors as well as local recurrence-free survival was analyzed in correlation with the type of surgical access used. Results Thirty-five patients were treated for RPS at our center. The majority received their primary RPS resection at a tertiary medical center (n = 23) the rest of the resection were performed in an external non-tertiary institution (n = 12). Median tumor size was 24 cm. Resections were performed via a midline laparotomy (MI = 31) or flank incision (FI = 4). All FI were performed at a non-tertiary center and received no multi-visceral resection. In ML the macroscopically complete resection (R0/1) rate was 83.9% and 25% in FI (p = 0.021). The local recurrence rate after R0/1 resection was 100% in FI and 61.5% in ML (p = 1.00). Early recurrence or local disease progression was present in 50% of FI compared to 0% in ML (p = 0.01). The median recurrence-free survival after R0/1 resection was lower in FI (p < 0.001) and in patients operated in a non-tertiary center (p = 0.27). Conclusions FI with limited exposure of the retroperitoneum and no access to the visceral organs as well as resection at a non-tertiary center are associated worse outcome in RPS surgery.