A systematic review of margin status in retroperitoneal liposarcomas: Does the R0 margin matter?

Benjamin Paik; Chin Jin Seo; Joey Wee-Shan Tan; Wen Kai Darryl Juan; Khee Chee Soo; Chin-Ann Johnny Ong; Claramae Shulyn Chia; Jolene Si Min Wong

doi:10.3389/fonc.2022.891710

A systematic review of margin status in retroperitoneal liposarcomas: Does the R0 margin matter?

Front Oncol. 2022 Aug 11:12:891710. doi: 10.3389/fonc.2022.891710. eCollection 2022.

Authors

Benjamin Paik^{1

2

3}, Chin Jin Seo^{1

2

4}, Joey Wee-Shan Tan^{1

2

5}, Wen Kai Darryl Juan^{1

2}, Khee Chee Soo^{1

2}, Chin-Ann Johnny Ong^{1

2

4

5

6

7}, Claramae Shulyn Chia^{1

2

4

6}, Jolene Si Min Wong^{1

2

4

6}

Affiliations

¹ Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
² Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore, Singapore.
³ Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
⁴ Sing Health Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
⁵ Laboratory of Applied Human GenetiCJS, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, Singapore.
⁶ Sing Health Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
⁷ Institute of Molecular and Cell Biology, ASTAR Research Entities, Singapore, Singapore.

Abstract

Retroperitoneal liposarcomas (RPLPSs) are a rare tumor group for which current guidelines recommend aggressive en bloc resection to attain microscopically negative (R0) margins. To ensure R0 margins, resection of adherent or adjacent organs is often required. However, it is still unclear if R0 margins confer any additional benefit to patients over a grossly negative but microscopically positive (R1) margin. We performed a systematic search of PubMed and Embase databases for studies including patients receiving R0 or R1 resection for RPLPS. Nine retrospective cohort studies, one prospective cohort study, and 49 case reports/case series were included. A total of 552 patients with RPLPS were evaluated: 346 underwent R0 resection and 206 underwent R1 resection. In the R0 group, 5-year overall survival (OS) ranged from 58.3% to 85.7%; local recurrence (LR) ranged from 45.5% to 52.3%. In the R1 group, 5-year OS ranged from 35% to 55.3%; LR ranged from 66.7% to 91.7%. Among cohort studies, OS, disease-free survival (DFS), LR rate, and LR-free survival (LRFS) were significantly associated with R0 resections. Assessment of case series and reports suggested that the R0 margin led to a slightly higher morbidity than that of R1. In conclusion, this review found the R0 margin to be associated with reductions in LR rates and improved OS when compared with the R1 margins, though accompanied by slight increases in morbidity. The roles of tumor histotype and perioperative chemotherapy or radiotherapy were not well-elucidated in this review.

Keywords: R0; liposarcoma; margin; retroperitoneal; sarcoma.

Publication types

Systematic Review