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October 1989

Long-term Results With Primary Retroperitoneal Tumors

Author Affiliations

From the Departments of Surgery, The Oregon Health Sciences University, Portland, Ore, (Drs Pinson and Fletcher) and the Lahey Clinic Medical Center, Burlington, Mass (Drs ReMine and Braasch). Dr Pinson was formerly a fellow in gastrointestinal surgery at the Lahey Clinic.

Arch Surg. 1989;124(10):1168-1173. doi:10.1001/archsurg.1989.01410100070012

• Primary retroperitoneal tumors represent a variety of lesions, with different treatments and prognoses. Of 182 patients in our study, retroperitoneal tumor was recognized preoperatively in only 39% of them. Sarcomas were most common (43% of patients), followed by lymphomas (23%), benign tumors (11%), undifferentiated malignant tumors (11%), carcinomas (8%), and germ cell tumors (4%). In 81 patients since 1960, the resection rate was 50%. Operative determinants of resectability were pathologic category and grade and extent of tumor. Resection included segments of the gastrointestinal tract (30% of the patients), kidney (25%), and pancreas, bladder, spleen, aorta, and vena cava (for each, 5% or less of the patients). The operative mortality was 6%. Tumor caused late death in 95% of the patients. Pathologic findings were a significant determinant of survival in the 81 patients. For sarcomas, 69% of the patients underwent resection, and the 1- and 5-year actuarial survival rates were 80% and 43%, respectively. Sixty percent of these patients underwent multiple operations. For lymphomas, most patients were treated with radiotherapy and chemotherapy; the 1- and 5-year survival rates were 67% and 35%, respectively. Benign tumors, almost all resected, yielded a 5-year survival rate of 100%. Undifferentiated tumors and carcinomas, most treated with radiotherapy and chemotherapy, had a 1-year survival rate of less than 33%. Other determinants of survival were age, weight loss, grade of tumor, and extent of tumor. Patients who underwent palliative resection had the same survival rate as patients who underwent biopsy alone. Complete surgical resection, if possible, is associated with the best survival rates for primary retroperitoneal tumors, and palliative resection is beneficial only to relieve symptoms.

(Arch Surg. 1989;124:1168-1173)