Sarcoma
non-CME
Amblessed Onuma, MD MS (he/him/his)
Resident
The Ohio State University Wexner Medical Center
Columbus, Ohio, United States
Disclosure information not submitted.
Amblessed Onuma, MD MS (he/him/his)
Resident
The Ohio State University Wexner Medical Center
Columbus, Ohio, United States
Disclosure information not submitted.
Melica Nikahd, MS
Biostatistician
The Ohio State University Wexner Medical Center- Department of Biomedical Informatics, United States
Disclosure information not submitted.
Diamantis I. Tsilimigras, MD
Postdoctoral Research Fellow
The Ohio State Wexner Medical Center
Columbus, Ohio, United States
Disclosure information not submitted.
Madison Hyer, MS
Biostatistician
The Ohio State University Wexner Medical Center- Center for Biostatistics, United States
Disclosure information not submitted.
Samantha Ruff, MD
Fellow
The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute, United States
Disclosure information not submitted.
Farhan Ilyas, B.S
Medical Student
The Ohio State University College of Medicine, United States
Disclosure information not submitted.
Carlo M. Contreras, MD
Associate Professor, Section Head of Melanoma/Sarcoma
The Ohio State University
Columbus, Ohio, United States
Disclosure(s): Association of Community Cancer Centers: Speaker (Terminated, May 1, 2022); Ohio State University: Research Grant (Ongoing); OncLive: Speaker (Terminated, November 2, 2022); Total Health Conferencing: Speaker (Terminated, October 31, 2022)
Valerie Grignol, MD
Associate Professor of Surgery
The Ohio State University
Columbus, Ohio, United States
Disclosure information not submitted.
Alex C. Kim, MD, PhD
Assistant Professor of Surgery
The Ohio State University Wexner Medical Center, The James Cancer Hospital and Solove Research Institute
Columbus, Ohio, United States
Disclosure information not submitted.
Raphael Pollock, MD PhD
Professor of Surgery, Director James Comprehensive Cancer Center
The Ohio State University Wexner Medical Center- Division of Surgical Oncology, United States
Disclosure information not submitted.
Timothy M. Pawlik, MD, PhD
Chair of Surgery
The Ohio State University Wexner Medical Center
Columbus, Ohio, United States
Disclosure(s): No financial relationships to disclose
Joal D. Beane, MD
Assistant Professor
The Ohio State University Wexner Medical Center- Division of Surgical Oncology
Columbus, Ohio, United States
Disclosure information not submitted.
Complete compartmental (CC) resection of retroperitoneal soft tissue sarcoma (RPS) is associated with increased morbidity but may not confer a survival benefit compared to tumor only (TO) resection. We sought to compare both approaches by utilizing the “win ratio” (WR), a novel statistical method that uses a composite of postoperative outcomes in a hierarchical order to define an overall benefit.
Methods:
Patients who underwent resection of RPS from 2004-2015 were identified from the National Cancer Database. CC resection was defined as partial or total removal of the primary site with a resection in continuity with other organs. Patients matched based on age group, tumor grade, stage, adjacent tumor involvement and Charlson Comorbidity index were compared and stratified WRs were assessed. Patients with R2 resection were excluded from the analysis. The WR was calculated based on a hierarchy of postoperative outcomes: 30-day and 90-day mortality, overall survival, 30-day readmission (Figure 1).
Results:
Among 1011 patients who underwent resection, the median age was 63 years (Interquartile Range 54-71) with a median follow-up of 51 months (IQR 28-85). Α total of 667 (66%) patients underwent CC for RPS, whereas 344 (34%) patients underwent TO resection. Overall, there was no difference in the win ratio among patients who underwent TO resection versus CC resection in the matched cohort (WR 0.83, 95% CI 0.61-1.09). In patients between the ages of 72-90, those who underwent CC resection had 37% lower odds of winning compared to patients undergoing TO resection (WR 0.63, 95%CI: 0.37, 0.98). A subgroup analysis of patients classified as not having adjacent tumor involvement at the time of surgery revealed that patients who underwent CC resection had 33% lower odds of winning compared to those who underwent TO resection (WR 0.67, 95%CI: 0.44-0.96).
Conclusions:
Based on win ratio assessments of a hierarchical composite endpoint, complete compartmental resection in patients without adjacent tumor involvement may not confer improved outcomes. This statistical method supports the rationale for less invasive resection of RPS in select patients, especially older patients.