Can primary retroperitoneal sarcoma benefit from aggressive resection when it is smaller than a baseball? ——A propensity score-matched analysis

Background and objectives: Multivisceral resection (MVR) is advocated by some high-volume sarcoma centers. The objective of this study was to investigate the therapeutic effect of MVR in primary retroperitoneal sarcoma (RPS) with tumor burden less than 10 ​cm. Methods: A retrospective analysis of patients with primary RPS who underwent radical surgical resection from 2009 to 2021 with lesions smaller than the size of a baseball (10 ​cm) was carried out. The incidence of postoperative morbidity and postoperative local recurrence-free survival rate of the MVR group and the non-MVR group were compared by propensity score-matching analysis. Results: A total of 319 patients with primary RPS underwent surgical resection, of which 95 patients (29.8%) had a tumor burden less than 10 ​cm, with 24 patients (25.3%) involved in the MVR group and 71 patients (74.7%) in the non-MVR group. After matching, the two groups showed no statistical difference at baseline, while the MVR group reported more postoperative complications (P ​= ​0.008) and a longer median postoperative hospital stay (P ​= ​0.002). In terms of local recurrence-free survival, there were no statistical difference between the two groups (P ​= ​0.269). Conclusions: Primary RPS patients with tumors smaller than baseball may not benefit from aggressive surgical strategy.