scholarly journals Primary Localized Retroperitoneal Sarcomas: Report from Slovenian Sarcoma Referral Center.

2020 ◽  
Author(s):  
Marko Novak ◽  
Andraz Perhavec ◽  
Milena Kerin Povsic ◽  
Matej Arnus ◽  
Darja Erzen
Keyword(s):  
High Volume ◽  
Soft Tissue Tumors ◽  
Retroperitoneal Sarcoma ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Compartmental Resection ◽  
Retroperitoneal Sarcomas ◽  
Local Recurrence Free Survival ◽  
Disease Specific

Abstract Background: Sarcoma patients should be treated in high volume referral sarcoma centers. Compartmental resection is proposed as best treatment option in retroperitoneal sarcoma patients. Methods: Institute of Oncology Ljubljana is the only referral sarcoma center in Slovenia. Having population of 2.1 million poses a unique situation. We manage all sarcoma patients in the country and operate on patients with soft tissue tumors of extremities, trunk and abdomen. Data for all consecutive patients surgically treated from January 1999 to December 2018 for primary localized retroperitoneal sarcoma was extracted from prospective surgical database. Clinicopathologic variables and the outcome were analyzed.Results: In total 89 patients were included. Mean age was 59.2 years. Dedifferentiated liposarcoma was the most common histology (38.2 %). Mean tumor size was 23.5 cm. Compartmental resection was performed in 47.2 % (42/89). Postoperative complication grade 3a or higher according to Clavien-Dindo classification had 30.3 % (27/89) of patients. The 30-day and 90-day mortality rate was 2.2 % and 5.6 %. Median follow-up was 62.1 months. Corresponding 5-year overall survival was 67.2 %, 5-year disease specific survival was 72.6 % and 5-year local recurrence free survival was 81.5 %, respectively. Conclusion: Results from our institution show that referral sarcoma centers may achieve very good results in management of retroperitoneal sarcoma patients, despite not meeting the criteria for high volume hospitals, as long as they have multidisciplinary team, appropriate facilities and expertise.

scholarly journals Primary localized retroperitoneal sarcomas. Report from Slovenian sarcoma referral center.

2020 ◽  
Author(s):  
Marko Novak ◽  
Andraz Perhavec ◽  
Milena Kerin Povsic ◽  
Matej Arnus ◽  
Darja Erzen
Keyword(s):  
High Volume ◽  
Soft Tissue Tumors ◽  
Retroperitoneal Sarcoma ◽  
Free Survival ◽  
Median Tumor Size ◽  
Compartmental Resection ◽  
Retroperitoneal Sarcomas ◽  
Local Recurrence Free Survival ◽  
Disease Specific

Abstract Background: Sarcoma patients should be treated in high volume referral sarcoma centers. Compartmental resection is proposed as the best treatment option in retroperitoneal sarcoma patients. Methods: Institute of Oncology Ljubljana is the only referral sarcoma center in Slovenia. Having population of 2.1 million poses a unique situation. We manage all sarcoma patients in the country and operate on patients with soft tissue tumors of extremities, trunk and abdomen. Data for all consecutive patients surgically treated from January 1999 to December 2018 for primary localized retroperitoneal sarcoma was extracted from a prospective surgical database. Data about the incidence of sarcoma patients in Slovenia was extracted from the Cancer Registry of Republic of Slovenia. Clinicopathologic variables and the outcome were analyzed.Results: In total 89 patients were included. Median age was 62 years. Dedifferentiated liposarcoma was the most common histology (38.2 %). Median tumor size was 21 cm. Compartmental resection was performed in 47.2 % (42/89). Postoperative complication grade 3a or higher according to Clavien-Dindo classification had 30.3 % (27/89) of patients. The 30-day and 90-day mortality rate was 2.2 % and 5.6 %. Median follow-up was 62.1 months. Corresponding 5-year overall survival was 67.2 %, 5-year disease specific survival was 72.6 % and 5-year local recurrence-free survival was 81.5 %, respectively. Conclusion: Results from our institution show that referral sarcoma centers may achieve very good results in management of retroperitoneal sarcoma patients, despite not meeting the criteria for high volume hospitals, as long as they have multidisciplinary team, appropriate facilities and expertise.

scholarly journals Primary localized retroperitoneal sarcomas: report from Slovenian sarcoma referral center

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Marko Novak ◽  
Andraž Perhavec ◽  
Milena Kerin Povšič ◽  
Matej Arnuš ◽  
Darja Eržen
Keyword(s):  
High Volume ◽  
Soft Tissue Tumors ◽  
Retroperitoneal Sarcoma ◽  
Free Survival ◽  
Median Tumor Size ◽  
Compartmental Resection ◽  
Retroperitoneal Sarcomas ◽  
Local Recurrence Free Survival ◽  
Disease Specific

Abstract Background Sarcoma patients should be treated in high volume referral sarcoma centers. Compartmental resection is proposed as the best treatment option in retroperitoneal sarcoma patients. Methods Institute of Oncology Ljubljana is the only referral sarcoma center in Slovenia. Having a population of 2.1 million poses a unique situation. We manage all sarcoma patients in the country and operate on patients with soft tissue tumors of extremities, trunk, and abdomen. Data for all consecutive patients surgically treated from January 1999 to December 2018 for primary localized retroperitoneal sarcoma was extracted from a prospective surgical database. Data about the incidence of sarcoma patients in Slovenia was extracted from the Cancer Registry of Republic of Slovenia. Clinicopathologic variables and the outcome were analyzed. Results In total, 89 patients were included in the study. Median age was 62 years. Dedifferentiated liposarcoma was the most common histology (38.2%). Median tumor size was 21 cm. Compartmental resection was performed in 47.2% (42/89). Postoperative complication grade 3a or higher according to Clavien-Dindo classification had 30.3% (27/89) of patients. The 30-day and 90-day mortality rate was 2.2% and 5.6%. Median follow-up was 62.1 months. Corresponding 5-year overall survival was 67.2%, 5-year disease-specific survival was 72.6%, and 5-year local recurrence-free survival was 81.5%, respectively. Conclusion Results from our institution show that referral sarcoma centers may achieve very good results in management of retroperitoneal sarcoma patients, despite not meeting the criteria for high volume hospitals, as long as they have multidisciplinary team, appropriate facilities, and expertise.

Intraoperative versus external beam boost for breast cancer: A matched-pair analysis.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1120-1120 ◽  
Author(s):  
Elena Sperk ◽  
Daniela Astor ◽  
Grit Welzel ◽  
Axel Gerhardt ◽  
Marc Suetterlin ◽  
...  
Keyword(s):  
Overall Survival ◽  
Local Recurrence ◽  
Breast Conserving Surgery ◽  
Matched Pair ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Matched Pair Analysis ◽  
Pair Analysis ◽  
Local Recurrence Free Survival

1120 Background: After breast conserving surgery, radiotherapy leads to a better overall survival. In addition to whole breast radiotherapy (WBRT) a boost to the tumor bed leads to a better local control. The tumor bed boost is usually added after WBRT or can be done intraoperative (IORT). Belletti et al. (Clin Cancer Res., 2008) described positive effects, an antitumoral effect and modulation of microenvironment after IORT with 50kV x-rays. A matched pair analysis was performed to investigate the impact of IORT boost on overall survival compared to standard external beam boost. Methods: Between 2002 – 2009, 370 patients were treated for breast cancer with WBRT + boost (external beam (EBRT) boost n = 146, IORT boost n =224). A matched pair analysis (1:1 propensity score matching for age, TNM, grading, hormonal treatment and chemotherapy) for overall survival and local recurrence free survival could be done for 53 pairs. All patients underwent breast conserving surgery and WBRT with 46-50Gy. 53 patients received an EBRT boost with 16Gy (2Gy/fraction, dedicated linear accelerator) and 53 patients received an IORT boost with 20Gy (INTRABEAM system, 50kV x-rays). Median follow-up was 6 months (range, 1-77 months) for the EBRT boost patients and 56 months (range, 2-97 months) for IORT boost patients. Kaplan Meier estimates were performed for overall survival and local recurrence free survival. Results: IORT boost patients had a longer follow-up than EBRT boost patients. Despite the difference in follow-up times, there was a strong trend towards better overall survival after IORT boost (90.2% vs. 62.3%, p = 0.375). One local recurrence was present in each group (EBRT boost after 15 months, local recurrence free survival 95%; IORT boost after 12 months, local recurrence free survival 98.1%). Conclusions: IORT given as a boost seems to have a positive impact on overall survival in breast cancer patients after breast conserving surgery. To identify such an effect a prospective randomized trial should be conducted.

scholarly journals Locally recurrent chondrosarcoma of the pelvis and limbs can only be controlled by wide local excision

2019 ◽  
Vol 101-B (3) ◽  
pp. 266-271 ◽  
Author(s):  
M. K. Laitinen ◽  
M. C. Parry ◽  
L-R. Le Nail ◽  
C. H. Wigley ◽  
J. D. Stevenson ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Primary Tumour ◽  
Surgical Margin ◽  
Recurrence Free Survival ◽  
Disease Specific Survival ◽  
Univariable Analysis ◽  
Free Survival ◽  
Local Recurrence Free Survival ◽  
Disease Specific ◽  
Significant Factors

Aims The purpose of this study was to investigate the potential for achieving local and systemic control after local recurrence of a chondrosarcoma of bone Patients and Methods A total of 126 patients with local recurrence (LR) of chondrosarcoma (CS) of the pelvis or a limb bone were identified from a prospectively maintained database, between 1990 and 2015 at the Royal Orthopaedic Hospital, Birmingham, United Kingdom. There were 44 female patients (35%) and 82 male patients (65%) with a mean age at the time of LR of 56 years (13 to 96). The 126 patients represented 24.3% of the total number of patients with a primary CS (519) who had been treated during this period. Clinical data collected at the time of primary tumour and LR included the site (appendicular, extremity, or pelvis); primary and LR tumour size (in centimetres); type of operation at the time of primary or LR (limb-salvage or amputation); surgical margin achieved at resection of the primary tumour and the LR; grade of the primary tumour and the LR; gender; age; and oncological outcomes, including local recurrence-free survival and disease-specific survival. A minimum two years’ follow-up and complete histopathology records were available for all patients included in the study. Results For patients without metastases prior to or at the time of local recurrence, the disease-specific survival after local recurrence was 62.5% and 45.5% at one and five years, respectively. After univariable analysis, significant factors predicting disease-specific survival were grade (p < 0.001) and surgical margin (p = 0.044). After multivariable analysis, grade, increasing age at the time of diagnosis of local recurrence, and a greater time interval from primary surgery to local recurrence were significant factors for disease-specific survival. A secondary local recurrence was seen in 26% of patients. Wide margins were a good predictor of local recurrence-free survival for subsequent recurrences after univariable analysis when compared with intralesional margins (p = 0.002) but marginal margins did not reach statistical significance when compared with intralesional margins (p = 0.084) Conclusion In cases of local recurrence of a chondrosarcoma of bone, we have shown that if the tumour is non-metastatic at re-staging, an increase in disease-specific survival and in local recurrence-free survival is achievable, but only by resection of the local recurrence with a wide margin. Cite this article: Bone Joint J 2019;101-B:266–271.

Neoadjuvant denosumab

2019 ◽  
Vol 101-B (2) ◽  
pp. 170-177 ◽  
Author(s):  
A. Puri ◽  
A. Gulia ◽  
P. Hegde ◽  
V. Verma ◽  
B. Rekhi
Keyword(s):  
High Risk ◽  
Local Recurrence ◽  
Local Control ◽  
Giant Cell Tumour ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
The Mean ◽  
Mean Time ◽  
Local Recurrence Free Survival

Aims The aims of this study were to evaluate the efficacy of preoperative denosumab in achieving prospectively decided intention of therapy in operable giant cell tumour of bone (GCTB) patients, and to document local recurrence-free survival (LRFS). Patients and Methods A total of 44 patients received preoperative denosumab: 22 to facilitate curettage, 16 to facilitate resection, and six with intent of converting resection to curettage. There were 26 male and 18 female patients. The mean age was 27 years (13 to 47). Results The mean number of denosumab treatments was five (2 to 7) per patient. In 42 of 44 patients (95%), denosumab helped to achieve prospectively decided intention. A total of 41 patients were available for follow-up at a mean follow-up of 34 months (24 to 48). There were 12 local recurrences (29%), in 11 patients (11/25, 44%) who had curettage and in one patient (1/16, 6%) who had resection. The mean time to local recurrence was 16 months (8 to 25). The LRFS was 76% at two years: 94% for cases with resection and 64% for cases with curettage (p = 0.013). Conclusion Although local control rates are unlikely to improve with use of preoperative denosumab, a short preoperative course of denosumab can facilitate surgery in certain cases of operable GCTB, with a high risk of local recurrence making curettage or resection technically easier. It may also help in converting a lesion requiring resection to a lesion that could possibly be treated with curettage.

Robot-assisted radical cystectomy (RARC) versus open radical cystectomy (ORC): Oncological outcomes in 469 patients with a mean follow-up of five years.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 492-492
Author(s):  
Kassem Faraj ◽  
Kyle Rose ◽  
Haidar Abdul-Muhsin ◽  
Anojan Navaratnam ◽  
Michael Patton ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radical Cystectomy ◽  
High Volume ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Patient Demographics ◽  
Primary Bladder ◽  
Open Radical Cystectomy

492 Background: There is scant information about intermediate and long-term comparative outcomes between RARC and ORC, with the exception of a recent, small randomized-trial. We present our experience with RARC and ORC in managing bladder cancer patients who require cystectomy. Methods: A query of all patients who underwent radical cystectomy for a primary bladder tumor between 01/2007 and 6/2017 at our institution yield 469 patients. Data was collected on patient demographics, pre-operative information, operative details, pathology, and follow-up. Most RARCs were performed by a high-volume robotic surgeon who preferentially used the robotic approach at the start of all cases. Statistical analyses were generated using SPSS 22.0. Any open conversions were analyzed in the RARC cohort. Results: In 469 total patients, 197 (42.0%) and 272 (58.0%) underwent RARC and ORC, respectively. There were 163 (82.7%) and 224 (82.4%) males in each group and the mean ages (SD) were 71.5 (8.6) and 70.2 (10.5) years. Mean follow-up (SD) was 75 (37.7) and 61 (35.7) months, respectively. There were 130 (66.0%) and 172 (63.2%) patients who presented with T2 or greater disease (p=0.605). Soft-tissue margin rates were 4.1% for RARC and 6.7% for ORC patients (p=0.232). Neoadjuvant chemotherapy was used in 56.9% of RARC and 45.9% of ORC patients with ≥ cT2 disease (p=0.058). The 5-year overall survival was 60.0% vs 57.0% and the 10-year overall survival was 40.3% vs 44.8% for RARC vs. ORC patients, respectively (p=0.283). The 5-year recurrence-free survival was survival (RFS) was 71.7% vs 65.7% and the 10-year RFS was 70.5% vs 62.3% for the RARC vs. open groups, respectively (p=0.078). Aggressive histological variants, which were associated with greater likelihood for recurrence, were more common in the ORC group (13.7 vs. 22.4% p=0.013). Atypical recurrences (i.e. peritoneal, extrapelvic nodes) occurred in 6 (3.0%) and 14 (5.1%) RARC and ORC patients, respectively (p=0.266). Conclusions: In experienced hands, intermediate and long-term outcomes of RARC appear equivalent to ORC with regards to recurrence free survival, overall survival, and risk of atypical recurrences.

scholarly journals Should Contralateral Nodules Be an Indication of Total or Completion Thyroidectomy for Patients With Unilateral Papillary Thyroid Carcinoma?

2021 ◽  
Vol 12 ◽  
Author(s):  
Tengfei Ma ◽  
Haiyang Wang ◽  
Jifeng Liu ◽  
Jian Zou ◽  
Shixi Liu
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Survival Rates ◽  
Recurrence Free Survival ◽  
Completion Thyroidectomy ◽  
Papillary Thyroid ◽  
Free Survival ◽  
Benign Nodules ◽  
Disease Specific

ObjectiveTo determine whether papillary thyroid carcinoma (PTC) patients with benign or nonsuspicious nodules in the contralateral lobe have a higher rate of recurrence or worse survival after lobectomy compared to those without nodules in the contralateral lobe.MethodsAdult patients who underwent lobectomy and were diagnosed with unilateral PTC (2013-2015), were identified from an institutional database. Patients who previously had cytologically benign nodules or nonsuspicious nodules in the contralateral lobe comprised the contralateral nodule (CN) group. Patients who did not have nodules in the contralateral lobe comprised the unilateral nodule (UN) group.Results370 patients were included: 242 in the UN group and 128 in the CN group. After a median follow-up of 62 months (range, 16–85 months), recurrence was confirmed in 4.1% patients in the UN group and 5.5% patients in the CN group (p = 0.559). Clinical contralateral lobe PTC was detected in 2.9% (7/242) of patients from the UN group and 3.9% (5/128) of patients from the CN group (p = 0.601). The 5-year contralateral lobe recurrence-free survival (RFS) rates were 96.8% in the UN group and 97.4% in the CN group (p = 0.396). The 5-year loco-regional RFS rates were 98.4% in the UN group and 97.8% in the CN group (p = 0.690). The 5-year disease-specific survival rates were both 100%.ConclusionPTC patients with benign or nonsuspicious CNs have similar recurrence and survival rates after lobectomy compared to those without CNs. CNs alone should not be an indication for total or completion thyroidectomy.

scholarly journals The impact of method of distal ureter management during radical nephroureterectomy on tumour recurrence

2014 ◽  
Vol 8 (11-12) ◽  
pp. 845 ◽  
Author(s):  
Anil Kapoor ◽  
Shawn Dason ◽  
Christopher B. Allard ◽  
Bobby Shayegan ◽  
Louis Lacombe ◽  
...  
Keyword(s):  
Cox Regression ◽  
Tumour Recurrence ◽  
Management Approach ◽  
Management Technique ◽  
Recurrence Free Survival ◽  
Radical Nephroureterectomy ◽  
Distal Ureter ◽  
Free Survival ◽  
Cox Regression Analysis

Introduction: Radical nephroureterectomy for upper tract urothelial carcinoma (UTUC) must include some form of distal ureter management to avoid high rates of tumour recurrence. It is uncertain which distal ureter management technique has the best oncologic outcomes. To determine which distal ureter management technique resulted in the lowest tumour recurrence rate, we analyzed a multiinstitutional Canadian radical nephroureterectomy database.Methods: We retrospectively analyzed patients who underwent radical nephroureterectomy with distal ureter management for UTUC between January 1990 and June 2010 at 10 Canadian tertiary hospitals. Distal ureter management approaches were divided into 3 categories: (1) extravesical tenting for ureteric excision without cystotomy (EXTRAVESICAL); (2) open cystotomy with intravesical bladder cuff excision (INTRAVESICAL); and (3) extravesical excision with endoscopic management of ureteric orifice (ENDOSCOPIC). Data available for each patient included demographic details, distal ureter management approach, pathology and operative details, as well as the presence and location of local or distant recurrence. Clinical outcomes included overall recurrence-free survival and intravesical recurrence-free survival. Survival analysis was performed with the Kaplan-Meier method. Multivariable Cox regression analysis was also performed.Results: A total of 820 patients underwent radical nephroureterectomy with a specified distal ureter management approach at 10 Canadian academic institutions. The mean patient age was 69.6 years and the median follow-up was 24.6 months. Of the 820 patients, 406 (49.5%) underwent INTRAVESICAL, 316 (38.5%) underwent EXTRAVESICAL, and 98 (11.9%) underwent ENDOSOPIC distal ureter management. Groups differed significantly in their proportion of females, proportion of laparoscopic cases, presence of carcinoma in situ and pathological tumour stage (p < 0.05). Recurrence-free survival at 5 years was 46.3%, 35.6%, and 30.1% for INTRAVESICAL, EXTRAVESICAL and ENDOSCOPIC, respectively (p < 0.05). Multivariable Cox regression analysis confirmed that INTRAVESICAL resulted in a lower hazard of recurrence compared to EXTRAVESICAL and ENDOSCOPIC. When looking only at intravesical recurrence-free survival (iRFS), a similar trend held up with INTRAVESICAL having the highest iRFS, followed by ENDOSCOPIC and then EXTRAVESICAL management (p < 0.05). At last follow-up, 406 (49.5%) patients were alive and free of disease.Conclusion: Open intravesical excision of the distal ureter (INTRAVESICAL) during radical nephroureterectomy was associated with improved overall and intravesical recurrence-free survival compared with extravesical and endoscopic approaches. These findings suggest that INTRAVESICAL should be considered the gold standard oncologic approach to distal ureter management during radical nephroureterectomy. Limitations of this study include its retrospective design, heterogeneous cohort, and limited follow-up.

scholarly journals Perioperative and Oncological Outcomes of 1,002 Consecutive Patients With Localized Renal Cell Carcinoma Treated by Robotic Partial Nephrectomy at a Single Center

2021 ◽  
Vol 19 (3) ◽  
pp. 183-192
Author(s):  
Taejin Kim ◽  
Jae Hoon Chung ◽  
Hyun Hwan Sung ◽  
Hwang Gyun Jeon ◽  
Byong Chang Jeong ◽  
...  
Keyword(s):  
Survival Rate ◽  
Partial Nephrectomy ◽  
Death Rate ◽  
Perioperative Outcomes ◽  
Robotic Partial Nephrectomy ◽  
Recurrence Free Survival ◽  
Single Center ◽  
Free Survival ◽  
Oncological Outcomes

Purpose: To analyze and compare the results of robotic partial nephrectomy (RPN) at a single center with the previous large-scale studies in terms of perioperative and oncological outcomes.Materials and Methods: We retrospectively evaluated 1,013 cases of RPN in our center database from December 2008 to August 2018. Total 11 cases were excluded in final analysis. We evaluated perioperative outcomes as the Trifecta achievement, which is defined as no positive surgical margin (PSM), no perioperative complications greater than Clavien-Dindo classification I and a warm ischemia time of <25 minutes. In addition, we analyzed pathological and oncological outcomes; recurrence, metastasis, all-cause deaths, cancer-specific deaths, and 5-year survival rates.Results: In 1,002 cases, the Trifecta achievement was 61.1% (n=612). The postoperative complication was 18.4% (n=184) but most were grade 2 or less (14.9%, n=145). Ninety-three cases (9.28%) had benign and 907 cases (90.5%) had malignant pathologies. A local recurrence were 14 cases (1.54%) and distant metastasis were 20 cases (2.2%) during follow-up periods. Allcause death rate was 1.2% (n=11) and cancer-specific death rate was 0.2% (n=2). The median follow-up period was 39 months. A 5-year recurrence-free survival rate, cancer-specific survival rate, and overall survival rate were 95.2%, 99.7%, and 98.4%.Conclusions: In summary, our data shows comparable perioperative outcomes to other largescale studies of RPN in terms of the Trifecta achievement with similar baseline characteristics. In terms of oncological outcomes, there was lower rate of PSM and similar recurrence free survival rate.

The role of surgical access in retroperitoneal sarcoma resection - a retrospective study

2021 ◽  
Author(s):  
Pauline Aeschbacher ◽  
Attila Kollár ◽  
Daniel Candinas ◽  
Guido Beldi ◽  
Anja Lachenmayer
Keyword(s):  
Local Recurrence ◽  
Medical Center ◽  
Retroperitoneal Sarcoma ◽  
University Hospital ◽  
Recurrence Free Survival ◽  
Tertiary Institution ◽  
Midline Laparotomy ◽  
Free Survival ◽  
Surgical Access ◽  
Tertiary Center

Abstract Background Retroperitoneal sarcoma (RPS) is a rare disease often requiring multi-visceral and wide margin resections. Midline incision seems to be the access of choice. Up to now there is no evidence for the best surgical access. This study aimed to analyze the oncological outcome according to the incision used for the resection. Methods All patients treated for RPS between 2007 and 2018 at the Department of Visceral Surgery and Medicine of the University Hospital Bern and receiving a RPS resection in curative intent were included. Patient- and treatment specific factors as well as local recurrence-free survival was analyzed in correlation with the type of surgical access used. Results Thirty-five patients were treated for RPS at our center. The majority received their primary RPS resection at a tertiary medical center (n = 23) the rest of the resection were performed in an external non-tertiary institution (n = 12). Median tumor size was 24 cm. Resections were performed via a midline laparotomy (MI = 31) or flank incision (FI = 4). All FI were performed at a non-tertiary center and received no multi-visceral resection. In ML the macroscopically complete resection (R0/1) rate was 83.9% and 25% in FI (p = 0.021). The local recurrence rate after R0/1 resection was 100% in FI and 61.5% in ML (p = 1.00). Early recurrence or local disease progression was present in 50% of FI compared to 0% in ML (p = 0.01). The median recurrence-free survival after R0/1 resection was lower in FI (p < 0.001) and in patients operated in a non-tertiary center (p = 0.27). Conclusions FI with limited exposure of the retroperitoneum and no access to the visceral organs as well as resection at a non-tertiary center are associated worse outcome in RPS surgery.

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