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Retroperitoneal Sarcoma Surgery — SCE Medical Oncology MCQ

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HardSarcomaRetroperitoneal Sarcoma SurgerySCE Medical Oncology

A 50-year-old woman with a retroperitoneal well-differentiated liposarcoma (WDLPS) undergoes complete resection. MDM2 and CDK4 are amplified by FISH. At follow-up, she develops a local recurrence. What surgical principle is most important for retroperitoneal sarcoma recurrence?

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Correct answer: E — Compartmental resection — en-bloc removal of the tumour with adjacent organs (kidney, colon) that served as the tumour margin, to achieve macroscopically complete resection

Retroperitoneal sarcomas (particularly WDLPS/DDLPS) have high local recurrence rates (40-60%) because true wide margins are difficult to achieve in the retroperitoneum. The approach of extended compartmental resection (en-bloc removal with adjacent organs forming the surgical margin — ipsilateral kidney, colon, psoas — even if not directly invaded) was pioneered by Gronchi et al. This provides the best chance of macroscopic complete resection. Incomplete resection does not improve outcomes. Referral to specialist sarcoma centres is essential.

Reference: ESMO 2024 STS Guidelines; STRASS; Gronchi et al Ann Surg 2009