Surgical aspects in the treatment of retroperitoneal soft tissue sarcomas

Abdominal soft tissue sarcomas (ASTS) represent a rare malignancy of the abdomen. Diagnosis is often delayed because ASTS tend to be asymptomatic for a long time. Typical clinical symptoms such as pain and augmentation of the abdominal girth develop as a result of the compressing and displacing rather than infiltrating growth pattern of large ASTS. Treatment of patients with ASTS should be managed interdisciplinarily in a tumourboard. Surgery (i.e. wide excision with negative margins) represents the only potentially curative treatment option. Multimodal treatment with radiotherapy and/or chemotherapy, however, is indispensable to reduce the rather high local recurrence rate in these patients despite complete resection. A preoperative core needle biopsy is recommended if diagnosis and hence also therapy are unclear: the biopsy pathway should be chosen in accordance with the surgeon, and the excision has to be performed afterwards within primary surgery. The aggressiveness of surgery is still under debate and ranges from a tissue/organ-sparing approach to an extensive approach with compartmental resection. Thus, the oncologic surgeon must be able to handle complex multivisceral resection as well as extensive vascular reconstruction. Surgery for local recurrence has been shown to be feasible, and the presence of distant metastases usually represents a contraindication for surgery.