Surgical resection for well differentiated liposarcomas of the retroperitoneum

Shimul A Shah, Flavio G Rocha, Robert T Osteen, Samuel Singer, Richard S Swanson
Brigham and Women's Hospital, Boston, MA

Hypothesis: Initial complete gross resection is associated with improved survival in well-differentiated liposarcomas of the retroperitoneum (WDLR).
Design:
Retrospective analysis of consecutive patients with WDLR.
Setting:
Tertiary referral institution.
Patients:
All patients who underwent resection for WDLR from 1990-2001.
Main Outcome Measures:
Variables examined included presentation, tumor size, margins, recurrence and survival.
Results:
43 patients with WDLR underwent resection in the 11-year span with 21 patients initially treated at BWH and 22 patients referred after previous surgery at an outside hospital. Complete surgical excision was attempted in 39/43 (91%) with 87% requiring resection of involved adjacent organs. All gross disease was removed in 77% (33/43) of patients, while positive margins were present in 23% (10/43). Median follow-up time was 37 months. The local recurrence rate after resection was 14% (3/21) in primary tumors and 54% (12/22) in those referred with local recurrence. The overall median time to recurrence was 59 months. A gross positive margin was a negative prognostic value for survival (p<0.05). Local recurrence increased chance of death 6.5 fold (p<0.05) while the average resections performed was 2.1 per patient. The histology changed to de-differentiated liposarcoma in 60% (9/15) of the recurrences. Overall 5-year survival was 63%.
Conclusions:
A complete gross resection (R0,R1) was associated with improved survival. Local recurrence increases chance of death by 6.5 fold with 60% progressing to high grade dedifferentiated liposarcoma. This report further emphasizes the importance of a grossly negative margin resection at primary presentation to optimize survival in patients with WDLR.

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