S. J. Judge1, K. Lata-Arias5, M. Yanagisawa1, M. A. Darrow3, A. M. Monjazeb4, S. W. Thorpe2, A. R. Kirane1, R. J. Bold1, D. J. Canter5, R. J. Canter1 1University Of California – Davis,Surgical Oncology,Sacramento, CA, USA 2University Of California – Davis,Orthopedic Surgery,Sacramento, CA, USA 3University Of California – Davis,Pathology,Sacramento, CA, USA 4University Of California – Davis,Radiation Oncology,Sacramento, CA, USA 5Ochsner Health System,Urologic Oncology,New Orleans, LA, USA
Introduction:
Advocates of extended surgical resection to optimize oncologic outcomes in retroperitoneal sarcoma (RPS) are increasing, and selected studies have demonstrated that short- and long-term outcomes following multivisceral resection (MVR) of RPS are acceptable. We sought to analyze surgical outcomes following RPS resection in a contemporary cohort, hypothesizing that 30-day morbidity and mortality rates and prevalence of MVR in a larger sample size would remain consistent with prior studies.
Methods:
Utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, we identified 636 patients with primary malignant neoplasms of the retroperitoneum from 2012 to 2015. Overall morbidity, severe morbidity, and mortality rates were compared among MVR and non-MVR patients, and univariate and multivariate analysis was performed to identify predictors of overall and severe postoperative morbidity (mortality rate was too low for meaningful analysis). The Cochran-Armitage trend test was used to assess for temporal trends in the utilization of MVR.
Results:
Of the 636 patients, 51% were female with a mean age of 59.8 ± 12.6 years. The majority were ASA class 3 (62%). Overall, median operative time was 228 minutes (range 47-987), and 256 (40%) underwent MVR (bowel resection = 119, nephrectomy = 91, cholecystectomy = 15). When comparing MVR to no MVR, there was no significant difference in overall morbidity (23% vs. 17%), severe morbidity (9% vs. 6%), and mortality (<1% vs. 2%), although overall morbidity approached statistical significance (P = 0.06). MVR patients did experience higher rates of deep incisional surgical site infection (SSI) (3% vs 1%, P = 0.03) and organ space SSI (7% vs 3%, P = 0.05) in the 30-day postoperative period. On multivariate analysis, MVR was not associated with increased overall morbidity (OR 0.92, 95% CI 0.57-1.49) or severe morbidity (OR 0.96, 95% CI 0.47-1.96). Rates of MVR ranged from a low of 38% in 2013 to a high of 45% in 2015 with no significant change over time (P = 0.53).
Conclusion:
Short-term morbidity and mortality rates after multivisceral resection of RPS remain acceptable, although rates of MVR show little change over time in NSQIP hospitals. Concerns about increased morbidity and mortality should not be viewed as a contraindication to wider implementation of extended resection for RPS.