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RPS: what is accepted /a standard

RPS: what is accepted /a standard. LRFS/OS are better w hen the patient is managed in a specialized center Percutaneous retroperitoneal core biopsy to confirm diagnosis/discuss neo adjuvant treatment/adapt extent of resection (except in typical case DD+WD LPS outside a trial)

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RPS: what is accepted /a standard

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  1. RPS: what is accepted/a standard • LRFS/OS are better when the patient is managed in a specialized center • Percutaneousretroperitoneal core biopsy to confirm diagnosis/discuss neo adjuvant treatment/adapt extent of resection (except in typical case DD+WD LPS outside a trial) • No open/laparoscopic biopsy/frozen section = peritoneal contamination/unhelpful/risks of mistakes • Most of the wrong surgeries are due to tumor left behind (bad analysis of imaging)/piecemeal resections • Primary en-bloc complete resection with uninvolved adjacent organs (with a balance with expected morbidity) to maximize the chances of negative margins to be considered on an individualized basis Technical Considerations in Surgery For Retroperitoneal Sarcomas. Position paper from e-SURGE, a masterclass in sarcoma surgery, and EORTC - STBSG Bonvalot S, Raut CP, Pollock RE , Rutkowski P, Strauss DC, Hayes AJ, Van Coevorden F, Fiore M, Stoeckle E, Hohenberger P and Gronchi A . Ann SurgOncol2012

  2. RPS: what is not a standard or under investigation • Neo-adjuvant chemotherapy in locallyadvanced RPS to renderthemresectable by shrinkage • IORT and post operativeradiotherapy have no provenvalue • Adjuvant chemotherapy after R0/R1 is limited benefit • EORTC randomizedprotocol 62092-22092 « STRASS » istesting the role of preopradiotherapy 50.4 gy/surgeryalone (oct 2013: 65pts/256)

  3. International collaboration isnecessary (prospective trials, registry)

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