Multivisceral resections for primary retroperitoneal sarcomas: impact of tumor multifocality on surgical and oncological outcomes

Retroperitoneal sarcomas (RPS) are rare tumors in which local recurrence is the primary cause of death. The key prognostic factor is the radicality of the primary surgery: 5-year survival after R0 resection reaches 70-80%, while after R1/R2 resection it drops to 40-60% and less than 30%, respectively [1].
Historically, the high recurrence rate (up to 80%) was associated with «enucleation» surgery, which left microscopic satellite lesions within the tumor pseudocapsule. The modern standard is extended multivisceral resections (MVR) which involve removal of the entire anatomical compartment in contact with the tumor to create a «tumor-free surgical field» [2, 3].
This aggressive surgical approach, planned by a multidisciplinary team, significantly improves local control and survival, especially in specialized high-volume centers.