Safety analysis on surgical treatment of elderly patients with primary retroperitoneal soft tissue sarcoma: a retrospective cohort study

doi:10.16139/j.1007-9610.2022.06.011

Abstract

Abstract:

Objective: To analyze the risk factors for postoperative complications of the elderly patients with primary retroperitoneal sarcoma(RPS). Methods: A retrospective cohort study was performed for elderly patients with primary RPS treated by soft tissue sarcoma multidisciplinary team Zhongshan Hospital from July 2009 to December 2020. Logistic regression analysis was used to find risk factors for postoperative complications. Results: A total of 98 cases were enrolled including male 54 cases and female 44 cases with 26 cases (26.5%) of age 70 years or older. Five-year overall survival following surgery was 61.2% (60 cases with 95% confidence interval, 49.1-73.7). Seventy-eight cases (79.6%) had tumor burden greater than 10 cm, and 87 cases (88.8%) with single lesion. There were 35 cases (35.7%) with well-differentiated liposarcoma, 31 cases (31.6%) with dedifferentiated liposarcoma, and 15 cases (15.3%) with leiomyosarcoma. A total of 96 cases(98.0%) underwent radical resection and 54 cases (55.1%) had more than one organ resected. The postoperative complications were found 55 cases (56.1%) and severe complications 16 cases (16.3%). Four cases (4.1%) died postoperatively. It was shown by multivariate analysis that both tumor burden greater than 10 cm (OR=4.597, P=0.012) and more than one organ resected (OR=4.858, P=0.003) were independent risk factors for postoperative complications in elderly patients with RPS. Conclusions: Operative treatment remained the preferred type for elderly cases with primary RPS and the surgery should be completed in high-flow centers of RPS.

Key words: Retroperitoneal sarcoma, Surgery, Elderly, Surgical safety, Complication

CLC Number:

ZHUANG Aobo, TONG Hanxing, ZHANG Yong, LU Weiqi, ZHOU Yuhong, LÜ Chentao. Safety analysis on surgical treatment of elderly patients with primary retroperitoneal soft tissue sarcoma: a retrospective cohort study[J]. Journal of Surgery Concepts & Practice, 2022, 27(06): 534-539.

Figures/Tables 4

References 10

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项目	例数（n=98）	有并发症发生（n=55）	无并发症发生（n=43）	χ²值	P值
性别				0.081	0.776
男	54（55.1）	31（56.4）	23（53.5）
女	44（44.9）	24（43.6）	20（46.5）
年龄（岁）				0.437	0.516
<70	72（73.5）	39（70.9）	33（76.7）
≥70	26（26.5）	16（29.1）	10（23.3）
症状				0.891	0.345
有	44（44.9）	27（49.1）	17（39.5）
无	54（55.1）	28（50.9）	26（60.5）
ASA评分（分）
1	51（52.0）	27（49.1）	24（55.8）
>1	47（48.0）	28（50.9）	19（44.2）
肿瘤负荷（cm）				9.884	0.002
<10	20（20.4）	5（9.1）	15（34.9）
≥10	78（79.6）	50（90.9）	28（65.1）
多灶				0.013	0.911
是	11（11.2）	6（10.9）	5（11.6）
否	87（88.8）	49（89.1）	38（88.4）
病理类型				7.774	0.169
高分化脂肪肉瘤	35（35.7）	19（34.6）	16（37.2）
去分化脂肪肉瘤	31（31.7）	22（40.0）	9（20.9）
平滑肌肉瘤	15（15.3）	6（10.9）	9（20.9）
孤立性纤维瘤	4（4.1）	2（3.6）	2（4.7）
恶性神经鞘膜瘤	2（2.0）	2（3.6）	0（0.0）
其他	11（11.2）	4（7.3）	7（16.3）
FNCLCC分级				0.694	0.707
Ⅰ	25（25.5）	13（23.6）	12（27.9）
Ⅱ	34（34.7）	21（38.2）	13（30.2）
Ⅲ	39（39.8）	21（38.2）	18（41.9）
新辅助放疗				0.032	1.000
是	5（5.1）	3（5.5）	2（4.7）
否	93（94.9）	52（94.5）	41（95.3）
新辅助化疗				0.013	0.911
是	11（11.2）	6（10.9）	5（11.6）
否	87（88.8）	49（89.1）	38（88.4）

项目	例数（n=98）	有并发症发生（n=55）	无并发症发生（n=43）	χ²值	P值
根治性切除				1.596	0.502
是	96（98.0）	53（96.4）	43（100.0）
否	2（2.0）	2（3.6）	0
联合脏器切除数				12.660	<0.001
0~1	44（44.9）	16（29.1）	28（65.1）
>1	54（55.1）	39（70.9）	15（34.9）
手术时间（h）				2.158	0.142
<4	42（42.9）	20（36.4）	22（51.2）
≥4	56（57.1）	35（63.6）	21（48.8）
术中出血量（mL）				10.543	0.001
<400	35（35.7）	12（21.8）	23（53.5）
≥400	63（64.3）	43（78.2）	20（46.5）
输注红细胞				6.110	0.013
是	57（58.2）	26（47.3）	31（72.1）
否	41（41.8）	29（52.7）	12（27.9）
术后转入ICU
是	53（54.1）	36（65.5）	17（39.5）	6.529	0.011
否	45（45.9）	19（34.5）	26（60.5）
术后住院时间（d）
<15	44（44.9）	9（16.4）	35（81.4）	41.254	<0.001
≥15	54（55.1）	46（83.6）	8（18.6）

临床病理因素	单因素分析			多因素分析
临床病理因素	OR	95%CI	P值	OR	95%CI	P值
性别（男比女）	1.491	0.499~4.455	0.474
年龄（≥70比<70）（岁）	0.853	0.237~3.062	0.807
症状（有比无）	0.827	0.273~2.507	0.738
ASA评分（>1比1）	1.082	0.340~3.441	0.893
肿瘤负荷（≥10比<10）（cm）	4.583	00.909~23.099	0.065	4.597	1.398~15.110	0.012
多灶性疾病（是比否）	2.226	0.448~11.059	0.328
病理类型			0.640
去分化脂肪肉瘤比高分化脂肪肉瘤	4.670	0.778~28.047
平滑肌肉瘤比高分化脂肪肉瘤	2.356	0.254~21.884
孤立性纤维瘤比高分化脂肪肉瘤	1.542	0.089~26.779
恶性神经鞘瘤膜瘤比高分化脂肪肉瘤	NA	NA
其他比高分化脂肪肉瘤	1.423	0.154~13.161
FNCLCC分级			0.909
Ⅱ比Ⅰ	1.478	0.154~13.161
Ⅲ比Ⅰ	1.542	0.089~26.779
新辅助放疗（是比否）	0.359	0.027~4.732	0.359
新辅助化疗（是比否）	2.585	0.381~17.533	0.331
根治性切除（是比否）	NA	NA	NA
联合脏器切除数（0~1比>1）	8.083	1.866~35.014	0.005	4.858	1.713~13.772	0.003
手术时间（≥4比<4）（h）	4.328	0.942~19.877	0.060	1.723	0.582~5.102	0.326
术中出血量（≥400比<400）（mL）	1.945	0.414~9.144	0.400
输注红细胞（是比否）	1.687	0.427~6.675	0.456
术后转入ICU（是比否）	1.423	0.336~6.924	0.632

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