Clinical experience with retroperitoneal soft tissue sarcomas

Öz

Aim/Objective: Retroperitoneal soft tissue sarcoma; epidemiological, histopathological features of cases in our clinic, treatments and their clinical courses were compared with the literature. Materials and Methods: Records of 7 patients who were operated in Surgical Oncology Clinics of Süleyman Demirel University between 2007-2013 after being detected with primary retroperitoneal- intraperitoneal masses in imagings and being reported as soft tissue tumor in histopathological examination were analyzed retrospectively. Results: The patients were 6 males and 1 female. Abdominal tomography was applied to all patients and in imagings there were both intraperitoneal and retroperitoneal masses in 4 patients (57,1%), left retroperitoneal masses in 2 patients (28,6%) and intraperitoneal mass in 1 patient (14,3%). Distant metastases weren’t detected in any of the patients at the time of diagnosis. While mass excision was done in 2 patients, enbloc organs resection (colon and kidney) was done along with excision in 3 patients, two patients were admitted as unresectable. In pathological examination, 42,9% (in 3 patient) good differential liposarcoma, 28,6% (in 2 patient) leiomyosarcoma and 14.3% (1 patient) dedifferentiated liposarcoma and rhabdomyosarcoma were detected. Recurrence developed in 2 patients who were applied mass excision in 11th month (10th month and 12th month) on the average. Lung metastases developed in one patient in the 6th month who were applied enbloc organ and mass resection. Conclusion: Retroperitoneal soft tissue sarcomas are rarely seen. However, recurrence often develops generally due to incomplete surgery. Therefore, aggressive surgery is recommended in these tumors in order to provide negative surgery border

Anahtar Kelimeler

• Sarcoma
• soft tissue
• retroperitoneal
• resection

Retroperitoneal yumuşak doku sarkomunda klinik deneyimlerimiz

Öz

Amaç: Retroperitoneal yumuşak doku sarkomlarında kliniğimizdeki vakaların
epidemiyolojik, histopatolojik özellikleri, uygulanan tedaviler ve klinik seyirleri literatür ile
karşılaştırıldı. Gereç ve Yöntem: Süleyman Demirel Üniversitesi Cerrahi Onkoloji Kliniğinde
2008-2013 yılları arasında görüntülemelerde primer retroperitoneal-intraperitoneal kitle
saptanıp operasyona alınan ve histopatolojik incelemesi yumuşak doku tümörü olarak
raporlanan 7 hastanın kayıtları retrospektif olarak incelendi. Bulgular: Hastaların 6’sı erkek
1 kadındı. Tüm hastalara abdominal tomografi uygulandı ve görüntülemede 4 hastada
(%57,1) hem intraperitoneal hem retroperitonel 2 hasta (%28,6) sol retroperitonealde ve
1 hastada (%14,3) intraperitoneal kitle mevcuttu. Tanı anında hiçbir hastada uzak organ
metastazı saptanmadı. Hastaların 2’sine kitle eksizyonu, 3’üne kitle ile birlikte en-blok organ
rezeksiyonu (kolon ve böbrek) yapılırken 2 hasta rezektable değildi. Patolojik incelemede
%42,9 (3 hasta) iyi differansiye liposarkom, %28,6 (2 hasta) leiomyosarkom, %14,3 (1
hasta) rabdomyosarkom ve indiferansiye liposarkom saptandı. Kitle eksizyonu uygulanan 2
hastada ortalama 11.ayında (10.ay ve 12.ay) nüks gelişti. Kitle ile en blok organ rezeksiyonu
yapılan bir hastada ise 6.ayında akciğer metastazı gelişti. Sonuç: Retroperitoneal yumuşak
doku sarkomları nadir izlenmektedir. Ancak genellikle yetersiz cerrahiye bağlı olarak nüks
sıklıkla gelişmektedir. Bundan dolayı negatif cerrahi sınır sağlamak için bu tümörlerde
agresif cerrahi önerilmektedir. 

Anahtar Kelimeler

• Sarkom
• yumuşak doku
• retroperiton
• rezeksiyon

Kaynakça

1. Sogaard AS, Laurberg JM, Sorensen M, Sogaard OS, Wara P, Rasmussen P, Laurberg S. Intraabdominal and retroperitoneal soft-tissue sarcomas-outcome of surgical treatment in primary and recurrent tumors. World J Surg Oncol. 2010; 12: 8-81.
2. Lewis JJ, Brennan MF. Soft tissue sarcomas. Curr Probl Surg. 1996; 33: 817–872.
3. Miettinen M, Sarlomo-Rikala M, Sobin LH, Lasota J. Gastrointestinal stromal tumors and leiomyosarcomas in the colon: a clinicopathologic, immunohistochemical, and molecular genetic study of 44 cases. Am J Surg Pathol. 2000; 24: 1339–1352.
4. Liles JS, Tzeng CW, Short JJ, Kulesza P, Heslin MJ. Retroperitoneal and intra-abdominal sarcoma. Curr Probl Surg. 2009; 46: 445-503.
5. Lewis JJ, Leung D, Woodruff JM, Brennan MF. Retroperitoneal soft-tissue sarcoma: analysis of 500 patients treated and followed at a single institution. Ann Surg. 1998; 228: 355– 365.
6. Miettinen M, Sarlomo-Rikala M, Lasota J. Gastrointestinal stromal tumors: recent advances in understanding of their biology. Hum Pathol. 1999; 30: 1213–1220.
7. Grimer R, Judson I, Peake D, Seddon B. Guidelines for the management of soft tissue sarcomas. Sarcoma. 2010; 2010: 506182.
8. Zahm SH, Fraumeni JF Jr. The epidemiology of soft tissue sarcoma. Semin Oncol 1997; 24: 504-514.

9. John E. Mullinax, MD, Jonathan S. Zager, MD, and Ricardo J. Gonzalez, MD. Current Diagnosis and Management of Retroperitoneal Sarcoma. Cancer Control. 2011; 18: 177- 187.
10. Lahat G, Dhuka AR, Lahat S, Smith KD, Pollock RE, Hunt KK, Ravi V, Lazar AJ, Lev D. Outcome of locally recurrent and metastatic angiosarcoma. Ann Surg Oncol. 2009; 16: 2502-2509.
11. Bonvalot S, Rivoire M, Castaing M, Stoeckle E, Le Cesne A, Blay JY, Laplanche A. Primary retroperitoneal sarcomas: a multivariate analysis of surgical factors associated with local control. J Clin Oncol. 2009; 27: 31-37.
12. Russo P, Kim Y, Ravindran S, Huang W, Brennan MF. Nephrectomy during operative management of retroperitoneal sarcoma. Ann Surg Oncol. 1997; 4: 421- 424.
13. Gronchi A, Lo Vullo S, Fiore M, Mussi C, Stacchiotti S, Collini P, Lozza L, Pennacchioli E, Mariani L, Casali PG. Aggressive surgical policies in a retrospectively reviewed single-institution case series of retroperitoneal soft tissue sarcoma patients. J Clin Oncol. 2009; 27: 24-30.
14. Van Dalen T, Hennipman A, Van Coevorden F, Hoekstra HJ, van Geel BN, Slootweg P, Lutter CF, Brennan MF, Singer S. Evaluation of a clinically applicable post-surgical classification system for primary retroperitoneal soft-tissue sarcoma. Ann Surg Oncol. 2004; 11: 483-90.