Development of a surgical complexity score to predict postoperative morbidity following primary retroperitoneal sarcoma resection: a collaborative study from the Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG)

Résumé fourni par la source

Soft tissue sarcomas (STS) are a rare group of neoplasms that demonstrate diverse tumour biology influenced by both histology and anatomic location. Approximately 15–20% of STS arise in the retroperitoneum1,2. In the absence of effective (neo)adjuvant therapies, a macroscopically complete (R0/R1) resection remains the cornerstone of treatment for patients with localized primary retroperitoneal sarcomas (pRPS). These tumours are commonly large and often abut/involve multiple adjacent viscera. The extent of resection is dictated by anatomical considerations and frequently requires multivisceral resection en bloc with the tumour3,4. Histologic type also informs the extent of resection, based on predilection for histopathologic organ invasion as well as underlying inherent tumour biology that predicts the risk of local and/or distant recurrence5–7. Despite optimal surgery, recurrence rates are high depending on the histology8–13. The aggressiveness of surgery has been somewhat tempered by the potential morbidity rate associated with multivisceral resection14. Surgical risk assessment is a critical step when planning any operation. Assessment of perioperative morbidity rate in patients undergoing resection for pRPS has been challenging to quantify. A tool frequently used to assess perioperative morbidity and mortality rates is the American College of Surgeons National Surgical Quality Improvement Program's (ACS NSQIP) surgical risk calculator (http://riskcalculator.facs.org)15. This incorporates a current procedural terminology (CPT) code and 19 preoperative patient variables to predict probability of 12 different postoperative outcomes including major complications, reoperation, and death. The patient characteristics included in the calculator are variables that are known prior to surgery such that the anticipated operation can be used to assess preoperative surgical risk as well as guide the informed consent process. One of the shortcomings of this calculator for discussions with patients planned for resection of pRPS is that there is significant variability in the extent and complexity of operations that may be described by a single CPT code corresponding to the resection of a retroperitoneal mass.

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