(P 388) THE ROAD TO CURATIVE SURGERY IN RETROPERITONEAL SOFT TISSUE SARCOMA: A DIFFERENT PATH IN THE ELDERLY?

Objective: Retroperitoneal sarcomas (RPS) are a rare and diverse group of malignant tumors originating in the connective tissues of the retroperitoneum. These tumors pose significant surgical challenges due to their size, location, and potential involvement of adjacent structures. In recent years, elderly patients are increasingly being offered surgical treatment for RPS. Whether old age should be a contraindication to radical surgery in these cases remains to be defined. Additionally, the preoperative surgical risk assessment and stratification are often not customized for elderly patients. Our study aims to compare surgical and oncological outcomes in elderly and young populations after radical resection for RPS at a tertiary referral center.

Methods: A series of 270 patients who underwent surgery in the Sarcoma Surgery Unit at IRCCS Humanitas Research Hospital (Rozzano, Milan) from 2010 to 2023 for primary or recurrent sarcoma of the retroperitoneum and pelvis were retrospectively reviewed from a prospectively maintained database. Elderly patients were defined as those aged 70 years or older. Preoperative assessments, including clinical and specialized instrumental evaluations, American Society of Anesthesiologists (ASA) status, and Clinical Frailty Scale (CFS), were retrieved. Complications were classified according to the Clavien-Dindo Classification (CDC) and Comprehensive Complications Index (CCI). Complications were categorized into surgical and medical. The primary endpoints were postoperative length of stay (PLOS), perioperative 30-day morbidity, and mortality. The secondary endpoints were local recurrence (LR), distant metastasis (DM), and overall survival (OS).

Results: Eighty-eight (32.6%) patients were classified as elderly, and 182 (67.4%) as young. The elderly group showed a higher prevalence of patients classified as ASA 3-4 (37.5% vs. 15.9%; p = 0.002) and more frail individuals (CFS score ≥ 4) compared to the young group (26.1% vs. 5.5%; p < 0.001). The median PLOS was 14 days in the elderly group and 10.5 days in the young group (IQR 9–21 vs. 7–18; p = 0.006). Medical postoperative complications were more common in the elderly group (43.2% vs. 28%; p = 0.02). Reoperation, readmission, and mortality were comparable between the two groups. The elderly group showed a higher overall CCI and higher medical CCI (p = 0.05 and p = 0.004, respectively). The median follow-up was 30.5 months (IR 10.8-63.8) in the elderly group and 31.5 months (IR 13.2-70.7) in the young group (p = 0.42). Figure 1 illustrates the Kaplan-Meier survival curves for the study population. LR and DM were comparable between the groups. Overall survival was reduced in the elderly group (p < 0.001).

Conclusion: Our study highlights that while elderly patients undergoing radical resection for RPS face increased medical postoperative complications, surgical complications remain comparable to younger patients. The extended PLOS in elderly patients indicates a greater need for postoperative care and monitoring. Despite these challenges, the incidence of reoperation, readmission, and immediate postoperative mortality did not significantly differ between the elderly and young groups.
The reduced OS in the elderly group highlights a disparity needing further investigation. This may be due to factors such as baseline health status, comorbidities, and the biological behavior of sarcomas in older individuals.
In conclusion, age alone should not contraindicate radical surgery for RPS. Comprehensive preoperative assessments and tailored perioperative care are essential for elderly patients. Thorough evaluation and individualized treatment plans can lead to successful surgical outcomes. Further studies are needed to refine risk stratification and develop optimized care pathways.