Impact of surgical radicality on long-term outcomes in patients with primary retroperitoneal sarcoma

Retroperitoneal sarcomas (RPS) represent a rare (0.5–1.0 cases per 100,000 population per year) and heterogeneous 
group of malignant tumors characterized by complex anatomy and high risk of local recurrence. Despite their low incidence, 
local disease progression is the primary cause of patient mortality, highlighting the critical importance of radical primary 
treatment.
The key problem determining unfavorable prognosis is the extremely high risk of local recurrence, reaching up to 
70% of cases, which often develops without concomitant distant metastases. This aggressive local nature of the disease 
is associated with anatomical features of the retroperitoneal space, which has a large reserve volume allowing tumors 
to reach significant sizes before clinical symptoms appear, as well as proximity to vital structures that often makes truly 
radical resection impossible.
The critical factor determining prognosis is the radicality of primary surgical intervention. Achievement of microscopically 
negative resection margins (R0) is associated with 70-80% 5-year survival, while microscopically positive margins (R1) reduce 
this rate to 40–60%, and macroscopically incomplete tumor removal (R2) – to less than 20–30%. Therefore, investigation 
of factors influencing achievement of radical resection and survival outcomes represents significant clinical interest and 
determines the relevance of the present study.