Illustration of personalized cancer surgery with data-driven insights.

Rethinking Retroperitoneal Sarcoma Surgery: Is Less Really More?

Mira Elwood in Health & Wellness December 2025 • 4 min read.

"A new study challenges the 'one-size-fits-all' approach to retroperitoneal sarcoma surgery, advocating for personalized resection strategies."

Retroperitoneal sarcomas (RPS), cancers lurking behind the abdominal lining, pose a significant surgical challenge. The standard approach involves removing the tumor along with any organs it touches, aiming for a complete resection. However, this aggressive strategy hasn't always translated into improved long-term survival for patients.

This reality has sparked a debate: is a more extensive surgery always better? Some European centers have experimented with wider resections, removing even seemingly uninvolved organs to decrease the chance of the cancer returning locally. While this approach sometimes lowers recurrence rates, it hasn't consistently boosted overall survival and leads to more complications.

To address this controversy, a new study has investigated the rationale behind individual organ resections in RPS surgery. The goal was to determine the extent to which cancer cells had invaded organs removed during surgery, paving the way for a more tailored approach to resection.

The Key to Personalized Resection: Understanding Organ Invasion

Illustration of personalized cancer surgery with data-driven insights.

The recent study highlights that the likelihood of cancer cells invading adjacent organs (histopathologic organ invasion, or HOI) can be predicted by the specific type of sarcoma and the reason for the organ's removal. This information is crucial for guiding surgeons in determining the minimum extent of resection needed. The study found that organs removed as part of a more extensive, "en bloc" resection (removing the tumor and surrounding tissues as a single block) often showed no evidence of HOI.

It's critical to understand that the risk of HOI shouldn't be the only factor guiding surgical decisions. A wider resection might still be necessary in certain cases. The researchers aren't advocating for less aggressive surgery across the board. Instead, they're calling for a more consistent, technically sound approach that carefully considers the likelihood of organ invasion.

Anatomical Considerations: Factors like the involvement of blood vessels supplying the organ and whether the tumor encases the organ are crucial.
Tumor Biology: The specific type of sarcoma plays a significant role, influencing how the cancer spreads locally and to distant sites, and ultimately impacting survival.

Ultimately, these findings pave the way for personalized surgical strategies that balance the need for complete tumor removal with the desire to minimize unnecessary organ resection and improve patient outcomes.

The Future of RPS Treatment: A Data-Driven Approach

This research lays the groundwork for collecting prospective data to inform surgical decision-making based on specific organ and sarcoma types. The Transatlantic RPS Working Group (TARPSWG.org) is leading the charge, establishing treatment guidelines and building a platform to study management strategies tailored to specific sarcoma subtypes.

The goal is to move away from a 'one-size-fits-all' approach to a more nuanced, data-driven strategy guided by tumor biology and anatomical considerations. The results of the European Organization for Research and Treatment of Cancer (EORTC) phase 3 trial (STRASS), investigating the role of preoperative radiation therapy, will be a crucial step in refining local control strategies for RPS.

Further research is needed to standardize margin assessment (determining if cancer cells are present at the edge of the removed tissue) and to clarify what exactly constitutes 'organ invasion'. While wider resections may improve the chances of complete tumor removal, the benefit of converting a close margin (R1 resection) to a clear margin (R0 resection) remains uncertain and warrants further investigation.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1245/s10434-018-6979-3, Alternate LINK

Title: Aso Author Reflections: Rationale For Organ Resection For Retroperitoneal Sarcomas

Subject: Oncology

Journal: Annals of Surgical Oncology

Publisher: Springer Science and Business Media LLC

Authors: Mark Fairweather, Chandrajit P. Raut

Published: 2018-10-30

Everything You Need To Know

What exactly are retroperitoneal sarcomas (RPS), and why are they so challenging to treat surgically?

Retroperitoneal sarcomas (RPS) are cancers that develop in the retroperitoneum, the space behind the abdominal lining. Their location makes them difficult to detect early and surgically challenging to remove. The standard surgical approach involves removing the tumor along with any organs it touches to achieve a complete resection. The challenge lies in determining the optimal extent of resection to maximize patient outcomes.

How does this new study challenge the traditional approach to retroperitoneal sarcoma (RPS) surgery?

The recent study suggests that a 'one-size-fits-all' approach to retroperitoneal sarcoma (RPS) surgery may not be optimal. It indicates that personalized resection strategies, tailored to the specific type of sarcoma and the likelihood of cancer cell invasion into adjacent organs (histopathologic organ invasion, or HOI), can lead to better patient outcomes. This involves carefully considering factors like anatomical considerations and tumor biology to minimize unnecessary organ resection.

What does histopathologic organ invasion (HOI) mean in the context of retroperitoneal sarcoma (RPS) surgery, and why is it important?

Histopathologic organ invasion (HOI) is the presence of cancer cells in organs adjacent to the primary retroperitoneal sarcoma (RPS). The study found that the risk of HOI can be predicted by the specific type of sarcoma and the reason for the organ's removal. This understanding helps surgeons determine the minimum extent of resection needed, potentially avoiding unnecessary removal of organs that are unlikely to be affected by cancer cells. However, the risk of HOI should not be the *only* factor guiding surgical decisions, a wider resection might still be necessary in certain cases.

Besides the risk of histopathologic organ invasion (HOI), what other anatomical and biological factors are crucial when deciding on the extent of retroperitoneal sarcoma (RPS) surgery?

Factors such as the involvement of blood vessels supplying the organ and whether the retroperitoneal sarcoma (RPS) encases the organ are crucial anatomical considerations. The specific type of sarcoma significantly influences how the cancer spreads locally and to distant sites, ultimately impacting survival. Different sarcoma subtypes have varying propensities for organ invasion and recurrence, thus guiding surgical decisions. This means surgeons must consider the unique characteristics of each tumor when planning the resection.

What role does the Transatlantic RPS Working Group (TARPSWG.org) play in advancing the treatment of retroperitoneal sarcomas (RPS)?

The Transatlantic RPS Working Group (TARPSWG.org) is playing a vital role by establishing treatment guidelines and creating a platform to study management strategies tailored to specific sarcoma subtypes. This collaborative effort aims to collect prospective data to inform surgical decision-making, leading to personalized treatment plans and improved outcomes for retroperitoneal sarcoma (RPS) patients. This data-driven approach holds the promise of refining surgical techniques and optimizing patient care in the future.