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Marco Fiore marco.fiore@istitutotumori.mi.it

LONG TERM MORBIDITY AFTER MULTIVISCERAL RESECTION FOR PRIMARY RETROPERITONEAL SARCOMA. A monoinstitutional study. Marco Fiore marco.fiore@istitutotumori.mi.it. “ Extended surgical approach ”. Storm, Mahvi – Ann Surg 1990. Liberal en-bloc visceral resections.

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Marco Fiore marco.fiore@istitutotumori.mi.it

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  1. LONG TERM MORBIDITYAFTER MULTIVISCERAL RESECTIONFOR PRIMARY RETROPERITONEAL SARCOMA.A monoinstitutionalstudy Marco Fiore marco.fiore@istitutotumori.mi.it

  2. “Extendedsurgicalapproach” Storm, Mahvi – Ann Surg 1990 • Liberalen-blocvisceralresections • Loco-regionalperitonectomy and miomectomyof the psoas • Vascularsurgery and boneresection

  3. Extended surgery Limited surgery

  4. Postoperative Morbidity Grade 3  18% Grade 4  12% Grade 5  3%

  5. Long term…? Giorgione, Three Ages of man (1500-1501)

  6. INT Milan – 2002-2011 • Consecutive primary RPS surgicallytreated  “extendedmultivisceralresection policy” • Retrospectivestudy • Renalfunction(baseline; 6 months; censoredtime) • Late abdominalcomplications • Chronicpain & medications(BriefPainInventory) • LowerLimbNeurologicalimpairment(LowerExtremityFunctional Scale, LEFS)

  7. Lower limb neurological impairment… femoralis ilio-hypogastric ilio-inguinal genito-femoralis lateralisfemoral-cutaneous

  8. Results • 243 patients operated • 160 patients alive at time of the study • 91 (57%) evaluable for the study • 69 not included for • Refusal • … • Median follow up at time of study (for those who answered)  49 months

  9. Number of organ resected (91 pts) 0-1 organs: 17.60% ≥ 2 organs: 82.40% 0-3 organs: 52.75% ≥ 4 organs: 47.25% Nephrectomy: 65.93%

  10. Possiblecausesoflowerlimbneurologicalimpairment Psoas Muscle Resection Femoral Nerve Resection 3.4% 67.4%

  11. Oncologic Outcome 5-yr CCI for local recurrence 21% (16-28%, 95%CI) 5-yr CCI for distant metastasis 25% (20-32%, 95%CI) Poster 117 POST-RELAPSE OUTCOME OF RETROPERITONEAL SARCOMA TREATED BY PRIMARY EXTENDED RESECTION: MORE ABOUT THE TUMOR LESS ABOUT THE SURGEON Alex Gronchi1; Rosalba Miceli2; Marc Antoine Allard3; Dario Callegaro1; Cecile Le Pechoux4; Marco Fiore, MD1; Charles Honoré3; Roberta Sanfilippo5; Sara Coppola3; Silvia Stacchiotti, MD5; Philippe Terrier6; Paolo G. Casali5; Axel LeCesne7; Chiara Colombo1; Sylvie Bonvalot3

  12. Renal function Altered creatinine level ≥ 1.5 fold UNL “Creatinine index” = [Alt./Not alt. at timeofstudy] – [Alt./Not alt. at baseline] 14.7% in the subgroupwithnephrectomy 7.7% Only 1 patientneededhemodialysisforcontrolateralnephrolitiasis

  13. Late abdominal complication • Incisional hernia repair 3.3% • Bowel Obstruction 5.7% • Emergency surgery 4.4% • Change in defecation 44.8% • Incontinence 3.8% • Urinary incontinence 10.2%

  14. Chronic Pain intensity and QoL 6.7% “Brief Pain Inventory” : Assessment of any kind of pain (not necessarily due to previous surgery) 50% Visual Analogue Scale “Median pain over the last 24 hours”

  15. Chronic Pain intensity and QoL 6.7% 18.6% 16.9% 18.6% 11.9% 11.9% 11.9% 50%

  16. Lowerlimbneurologicalimpairment (…related to surgical procedure) • Postoperative Sensibility Disorder: 78.41% • Still present at time of study 71.79% • Medications needed 34.09%

  17. Lowerlimbneurologicalimpairment (…related to surgical procedure)

  18. Lowerlimbneurologicalimpairment (…related to surgical procedure) Median LEFS score  60 / 80 (38-79, IQ range)

  19. Who had LTM…? Bowel obstruction Emergency surgery Incisional hernia Change in defecation Change in urination Reduced libido Impotence Retrograde ejaculation Dyspareunia Accidental falls Lack of knee strenght Any ≥ 3 from the list

  20. Correlation with early postoperative morbidity Number of Long Term Morbidities Late Renal Morbidity Pain & QoL P = 0.01974

  21. Correlation with early postoperative morbidity LEFS Score at time of survey No Postoperative M Postoperative M P = 0.05218

  22. Conclusion • Primary extended multivisceral resection for RPS was followed by minor long term morbidities in 1/3 of patients (more frequent in case of early perioperative complications) • Chronic pain and lower limb function were acceptable • Late renal function was impaired in a minority of patients (7.7% overall; 14.7% after nephrectomy) • The impact on QoL deserves a prospective evaluation, since the baseline evaluation was not assessed • Outlined data favor the safety and feasibility of the extended approach and will be confirmed prospectively

  23. marco.fiore@istitutotumori.mi.it

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