Surgical challenges to retroperitoneal sarcomas
Dr Angelo Dei Tos – Department of Oncology, General Hospital of Treviso, Italy
Can you tell us about the talk you gave at ESMO?
This morning the first meeting was basically based on the retroperitoneal sarcomas. The issue is, first of all, the anatomic location is very peculiar so it’s a very complex anatomic area in which to achieve surgical radicality, it’s a big challenge. But it’s also an anatomic site where the disease is challenging itself because the variety of entities that you may have there. So what we tried, basically, to persuade attendees to the meeting is that first of all you need to know the disease. So the basis of any treatment, the prerequisite in order to bring to a patient the proper treatment, is to define that disease which is basically my job. Of course, because of the location, even that type of achievement is more challenging because you need to get material from the retroperitoneum, it’s more difficult than in any other somatic soft tissues or lesions or whatever. So the take home message has been please try to make a correct diagnosis and on that basis then you may decide what is the best treatment for the patient.
What sort of surgical procedures do we need to see?
The peculiarity of the anatomic location and the peculiarity of the disease make that a big challenge. If you want to be radical, if you want to give a chance to the patient, you need to do a multivisceral resection which means not simply taking out the tumour but sacrificing the surrounding tissue. But the surrounding tissue in the retroperitoneum has vital organs. So this is a big challenge for surgeons because they need to be very aggressive, this is the only way on specific histotypes to prolong the life of the patients.
What are the knock-on implications?
Not many actually, but of course when you take one kidney out, even giving chemo afterwards may be a problem. So you really need to know what type of disease you’re treating because otherwise complications may overrule the benefits, or the clinical benefits, of the decision that has been taken.
What impact does the variety have on the patient outcome?
In particular, for a lesion called the differentiated liposarcoma and well-differentiated liposarcoma is a specific histotype that is the commonest disease in the retroperitoneum, multivisceral resection is the key. It’s the key because this lesion rarely metastasises but they do recur locally and eventually kill the patient. So if you take out all what you can, those patients get an enormous benefit. On the other side, if the diagnosis is lymphoma, surgery is not even an option. If the histotype is leiomyosarcoma, which is a lesion that tends to metastasise, then you may decide not to go into visceral resection because basically the disease will spread to the liver, to the lungs, so why should you be so aggressive surgically. So histotype and pathological diagnosis is the thing that will lead the successful treatment for these patients.
You also chaired a table on sarcomas, can you tell us about that?
We had basically three talks. The first talk was on a very, very specific again organ, which is the uterus. Gynaecological sarcomas are very rare but they do represent a specific subset of diseases which needs particular attention. So Professor Reichardt there offered the current knowledge on systemic treatment for those specific subsets of sarcomas which actually are several, several different histotypes even within one single organ and mesenchymal tumours can be very, very… show broad differences. The second talk was on desmoid tumours from Sylvie Bonvalot and what she pointed out basically is that desmoid tumours are only locally aggressive lesions, it never metastasises. And there is a tendency to consider it as a benign disease, it’s not benign at all, it’s a terrible disease, very invalidating, a lot of mobility. Interestingly, from a surgical perspective, now there is a rising tendency not to treat the patient but to wait and see many, many times because many times it sounds like repeated surgery may be even as a problem as the disease itself. So it’s interesting to listen from the talk, to learn from a surgeon that no surgery may be the best option in those chances. In the end Paolo Casali from Milan tried to show again how important is pathological diagnosis in the perspective of treating those patients. Once sarcomas were treated as one disease and because of that, basically, we never demonstrated in such a sound manner that systemic treatments give so much advantage to these patients. But if you start treating them differently, according to the specific disease, we are quite confident that you will see the differences in favour of systemic treatments. That was basically what we discussed when I went out there.