Variations in surgical strategies and treatment allocation for retroperitoneal sarcomas across German-speaking sarcoma centres

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INTRODUCTION: Retroperitoneal sarcomas (RPS) require multidisciplinary decision-making. Following centre certification and the publication of national guidelines in German-speaking countries, the consistency and reliability of multidisciplinary team (MDT) recommendations for RPS remain unclear. MATERIALS AND METHODS: In this multi-centre study, 24 German-speaking sarcoma MDTs independently reviewed pre-treatment imaging and clinical information from 20 anonymised primary RPS cases. Centres provided standardised assessments of resectability, surgical strategy, and treatment allocation. Inter-centre agreement was quantified using percentage agreement with the per-case consensus and Krippendorff's alpha statistic (α), interpreted using established reference values. RESULTS: Review of the 20 cases resulted in up to 480 MDT assessments for each item. Across 468 assessments, 411 (88%) rated the tumour as resectable and 57 (12%) as non-resectable. Centre-level agreement with the per-case consensus was 90.2%, with fair inter-centre reliability (α = 0.21). Agreement was lower in large tumours (>20 cm: 79.6%, α = 0.27) compared with smaller tumours. Agreement on surgical strategy was 65.9% (284/431; α = 0.21), with marked variability in the extent of resection and the use of compartmental versus organ-sparing approaches. Agreement on treatment allocation was 75.6% (350/463; α = 0.24) with centres pursuing different subtype-specific treatment concepts. In 8 of 20 cases, at least one centre recommended palliative treatment while others proposed a potentially curative approach. CONCLUSION: The majority of patients were offered curative treatment options in almost all centres. Substantial variability was observed in histology-specific surgical strategies and treatment allocation. These findings indicate that centre-level interpretive frameworks substantially influence MDT recommendations. Strengthening cross-centre collaboration and refining histology-specific guidance may improve consistency in RPS care without undermining expert judgment.

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