Clinical Study Of Combined Organectomy For Primary Retroperitoneal Sarcoma

Objective: : To explore the causes,types and organ invasion of patients with primary retroperitoneal sarcoma combined with organectomy,as well as the factors affecting the prognosis of patients.Methods: A retrospective analysis of the clinical and pathological data of 129 patients with primary retroperitoneal sarcoma who underwent combined organ resection in the Affiliated Hospital of Qingdao University from January 2000 to December 2020.The follow-up date is as of February 28,2021.The content of the follow-up mainly includes postoperative survival and recurrence of patients with primary retroperitoneal sarcoma.Among the 129 patients,at least 1 organ was removed,and at most 7 organs were removed.The average number of removed organs per patient was 2,and the median was2.A total of 267 organs were removed.Pathologically confirmed organ invasion(n=109,40.8)%).Reasons for organ resection include suspected organ invasion/organs of tumor origin(n=27,10.1%),tumor involvement in peripheral vascular supply organs(n=37,13.9%),tumor-encapsulated organs(n=88,33.0%),tumor adhesion to Organs(n=111,41.6%),tumor adjacent organs/complete resection under microscope(R0/R1 resection)(n=3,1.1%),other organs that need to be removed such as iatrogenic injury(n=1,0.4%)).The organs removed included kidney(n=66,51.2%),colon(n=65,50.4%),adrenal gland(n=40,32.6%),spleen(n=20,15.5%),pancreas(n=16,12.4%),psoas major(n=15,11.6%),small intestine(n=13,10.1%),stomach(n=11,8.5%),liver(n=5,3.9%),blood vessel(n= 5,3.9%),ovary(n=5,3.9%),diaphragm(n=3,2.3%),uterus(n=2,1.6%),bladder(n=1,0.8%),the most commonly removed The organs are kidney(n=66,51.2%),colon(n=65,50.4%)and adrenal gland(n=40,32.6%).The invasion of each organ is as follows,kidney(n=26,39.4%),colon(n=30,46.2%),adrenal glands(n=4,10.0%),spleen(n=6,30.0%),pancreas(n=9,56.3%),psoas major(n=10,66.7%),Small intestine(n=9,69.2%),stomach(n=8,72.7%),liver(n=2,40.0%),blood vessels(n=3,60.0%),ovary(n=0,0%),Diaphragm(n=0,0%),uterus(n=1,50.0%),bladder(n=1,100%).To evaluate the patient’s organ resection and organ invasion,and to statistically analyze the factors that may affect the prognosis of patients with primary retroperitoneal sarcoma.Results: The 1-year progression-free survival rate of 129 patients was 95.3%,the 3-year progression-free survival rate was 31.1%,and the 5-year progression-free survival rate was 15.7%.Univariate analysis showed tumor grade(Log-Rank test: 2=14.256,P <0.001),multiple foci(Log-Rank test: 2=7.827,P=0.005),organ invasion(Log-Rank test:2=19.186,P<0.001)and whether radical resection(Log-Rank test: 2=66.144,P<0.001)is an important factor affecting the progression-free survival of patients with primary retroperitoneal sarcoma;multivariate analysis showed tumor grade(P=0.007,HR=1.788,95%CI 1.171-2.732),whether there is organ invasion(P=0.013,HR=1.858,95%CI1.141-3.026),whether radical resection(P<0.001,HR=6.813,95%CI 3.728-12.452)is an independent risk factor affecting the progression-free survival of patients with primary retroperitoneal sarcoma.The 1-year overall survival rate of 129 patients with primary RPS who underwent combined organ resection was 98.4%,the 3-year overall survival rate was78.1%,and the 5-year overall survival rate was 43.9%.Univariate analysis showed histological subtype(Log-Rank test: 2=6.581,P=0.010),tumor grade(Log-Rank test:2=18.115,P < 0.001),multiple lesions(Log-Rank test: 2= 9.438,P=0.002),organ invasion(Log-Rank test: 2=16.139,P<0.001),and whether radical resection(Log-Rank test: 2=28.077,P < 0.001)affects primary retroperitoneal sarcoma Important factors affecting the overall survival of patients;multivariate analysis showed tumor grade(P<0.001,RR=2.457,95%CI 1.499-4.027),multiple foci(P=0.020,RR=1.797,95%CI1.095-2.949),Organ invasion(P=0.009,RR=2.062,95%CI 1.201-3.541)and whether radical resection(P<0.001,RR=4.485,95%CI 2.411-8.343)affects the overall survival of patients with primary retroperitoneal sarcoma Independent risk factors.Conclusion: Among the 129 patients with primary RPS who underwent combined organ resection,more than half(60.5%)had evidence of organ invasion.Among the 267 organs removed,the proportion of organ invasion was 40.8%.Kidney and colon are the most common organs removed in primary RPS.39.4% of the kidneys have evidence of organ invasion,and 46.2% of the colon has evidence of organ invasion.Organ invasion,tumor grade,multiple foci and radical surgery are independent risk factors that affect the prognosis of patients with primary RPS.Retroperitoneal sarcoma of different pathological types has different ability to invade surrounding tissues and organs.