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Experience with surgical treatment of retroperitoneal soft tissue sarcomas at a university hospital in Thailand.
[liposarcoma]
Retroperitoneal
soft
tissue
sarcomas
(
RSTS
)
are
rare
malignant
tumors
with
a
distinguishing
feature
of
slow
growth
in
the
silent
retroperitoneal
space
.
The
patients
usually
present
late
with
a
large
retroperitoneal
mass
surrounded
by
the
major
vascular
structures
and
visceral
organs
rendering
curative
resection
an
extremely
difficult
and
risky
operation
.
The
purpose
of
the
present
study
was
to
demonstrate
surgical
experience
and
results
of
treatment
of
RSTS
at
King
Chulalongkorn
Memorial
Hospital
.
Operative
techniques
of
these
complex
surgical
procedures
were
also
described
.
A
retrospective
study
was
performed
in
patients
who
had
RSTS
and
underwent
surgical
resection
between
June
2003
and
November
2011
at
King
Chulalongkorn
Memorial
Hospital
,
Bangkok
,
Thailand
.
All
patients
were
followed
after
the
operations
until
death
or
last
follow-up
at
the
out-patient
clinic
in
October
2012
.
Data
collection
included
demographic
data
,
details
of
operations
,
operative
complications
,
neoadjuvant
and
adjuvant
chemoradiation
therapy
,
local
recurrence
,
treatment
of
local
recurrence
,
and
5
-
year
overall
survival
rate
.
Factors
associated
with
local
recurrence
were
also
examined
.
During
the
9
.
4
-
year
period
,
18
patients
entered
into
the
present
study
.
Fourteen
(
77
.
8
%
)
were
female
and
four
(
22
.
2
%
)
were
male
.
The
age
ranged
from
44
to
80
years
(
median
53
.
5
years
)
.
Duration
of
symptoms
ranged
from
one
week
to
24
months
(
median
3
.
5
months
)
.
The
tumor
size
ranged
from
10
to
48
cm
(
median
27
cm
)
in
greatest
dimension
.
All
patients
underwent
preoperative
CT
scan
.
Preoperative
core
needle
biopsy
was
performed
in
one
patient
.
One
patient
had
preoperative
radiation
therapy
.
Sixteen
patients
(
88
.
9
%
)
underwent
complete
gross
resection
(
CGR
)
(
R
0
or
R
1
resection
)
and
two
(
11
.
1
%
)
had
palliative
resection
(
R
2
resection
)
.
All
patients
who
had
CGR
(
n
=
16
)
had
one
or
more
contiguous
organ
resection
(
kidney
87
.
5
%
,
colon
50
%
,
or
adrenal
gland
43
.
7
%
)
.
The
operative
time
ranged
from
120
to
360
minutes
(
median
330
minutes
)
.
The
operative
blood
transfusion
ranged
from
0
to
12
units
(
median
2
.
5
units
)
.
Postoperative
bleeding
complication
requiring
reoperation
occurred
in
three
patients
(
16
.
7
%
)
.
One
patient
had
postoperative
uncomplicated
pancreatic
fistula
.
There
was
no
perioperative
mortality
.
The
final
pathological
reports
were
liposarcoma
in
15
patients
(
83
.
3
%
)
.
Other
histology
were
atypical
lipomatous
tumor
malignant
fibrous
histiocytoma
,
and
unspecified
spindle
cell
tumor
in
one
patient
each
.
Two
patients
who
had
palliative
resection
died
at
six
and
16
months
after
the
operations
.
Local
recurrence
occurred
in
five
patients
who
had
CGR
(
31
.
3
%
)
.
One
of
them
died
at
60
months
after
the
operation
.
The
median
follow-up
time
in
patients
who
underwent
CGR
was
39
.
5
months
(
range
12
-
114
months
)
.
The
5
-
year
overall
survival
of
the
entire
cohort
was
73
.
5
%
(
95
%
CI
:
44
.
3
-
88
.
4
%
)
.
The
5
-
year
overall
survival
of
patients
who
had
CGR
was
83
.
3
%
(
95
%
CI
:
53
.
5
-
98
.
5
%
)
.
Univariate
analysis
of
the
tumor
size
,
tumor
grading
,
status
of
the
surgical
margins
,
and
primary
operation
or
re
-resection
revealed
no
statistical
significance
in
patients
who
had
CGR
with
and
without
local
recurrence
.
Acceptable
outcomes
after
complete
surgical
resection
of
the
RSTS
were
achieved
from
this
small
but
important
case-series
.
The
authors
have
demonstrated
that
CGR
with
concomitant
resection
of
the
contiguous
organs
can
be
safely
performed
in
patients
with
large
RSTS
.
Preoperative
CT
scan
was
invaluable
for
diagnosis
and
treatment
plan
.
Preoperative
core
needle
biopsy
was
not
necessary
when
preoperative
CT
scan
was
diagnostic
.
Intention
for
curative
resection
should
be
attempted
whenever
possible
to
minimize
chance
of
local
recurrence
and
improve
survival
.
Experience
of
the
surgical
team
is
an
important
factor
for
successful
results
when
conducting
these
technically
demanding
operations
.
Diseases
Validation
Diseases presenting
"complete gross resection"
symptom
liposarcoma
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