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  1. Article ; Online: Author response to: Comment on: Assessment of inter-centre agreement across multidisciplinary team meetings for patients with retroperitoneal sarcoma.

    Tirotta, Fabio / Desai, Anant

    The British journal of surgery

    2023  Volume 110, Issue 12, Page(s) 1893

    MeSH term(s) Humans ; Sarcoma/surgery ; Retroperitoneal Neoplasms/surgery ; Soft Tissue Neoplasms ; Patient Care Team
    Language English
    Publishing date 2023-09-12
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 2985-3
    ISSN 1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
    ISSN (online) 1365-2168
    ISSN 0263-1202 ; 0007-1323 ; 1355-7688
    DOI 10.1093/bjs/znad293
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  2. Article ; Online: Evaluation of outcomes in the management of primary sporadic desmoid-type fibromatosis at a specialist soft tissue sarcoma unit.

    Khan, Misbah / Almond, Max / Ford, Samuel / Desai, Anant

    European journal of medical research

    2022  Volume 27, Issue 1, Page(s) 123

    Abstract: Background: Desmoids are rare fibroblastic tumours whose treatment in any individual case presents a persistent challenge. We endeavoured to evaluate various clinicopathological factors contributing to tumour behaviour.: Methods: This is a ... ...

    Abstract Background: Desmoids are rare fibroblastic tumours whose treatment in any individual case presents a persistent challenge. We endeavoured to evaluate various clinicopathological factors contributing to tumour behaviour.
    Methods: This is a retrospective review of 95 primary truncal sporadic fibromatosis managed between 2011 and 2020. We studied progression rate for wait and watch (WW) and recurrence rate for the surgically treated group as adverse events. Relevant event-free survivals and potential risk factors were analysed over a median follow-up of 27 months.
    Results: 66 patients (69.5%) received watchful surveillance and 28 upfront surgery. 2-year progression-free survival in WW group (88.9%) was higher than RFS in the surgical group (77.1%) p = 0.02. Adverse event rate compared favourably, 28.8% in WW and 28.6% in surgical group. At final follow-up, rate of stable disease for WW was 47%, and the regression rate was 24.2%. On Cox regression analysis, meantime to progress was 14 ± 2.0 months, with larger tumour size as a significant prognostic indicator (p = 0.05). Surgical group's mean time to recurrence was 13.8 ± 2.76 months, with tumour location a significant contributing factor (p = 0.05).
    Conclusions: This study confirms to the safety of both treatment approaches. Adverse event rates remained comparable, but event-free survival was longer for the watchful surveillance group.
    MeSH term(s) Fibromatosis, Aggressive/pathology ; Fibromatosis, Aggressive/surgery ; Humans ; Neoplasm Recurrence, Local ; Prognosis ; Retrospective Studies ; Sarcoma
    Language English
    Publishing date 2022-07-16
    Publishing country England
    Document type Journal Article
    ZDB-ID 1329381-3
    ISSN 2047-783X ; 0949-2321
    ISSN (online) 2047-783X
    ISSN 0949-2321
    DOI 10.1186/s40001-022-00751-7
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  3. Article ; Online: Primary retroperitoneal sarcoma: A comparison of survival outcomes in specialist and non-specialist sarcoma centres.

    Tirotta, Fabio / Bacon, Andrew / Collins, Shane / Desai, Anant / Liu, Hanhua / Paley, Lizz / Strauss, Dirk / Strauss, Sandra J

    European journal of cancer (Oxford, England : 1990)

    2023  Volume 188, Page(s) 20–28

    Abstract: Background: Consensus guidelines outline that patients with primary retroperitoneal sarcoma (RPS) should be managed within specialist sarcoma centres (SSC). There is, however, a paucity of population-based data detailing incidence and outcomes in these ... ...

    Abstract Background: Consensus guidelines outline that patients with primary retroperitoneal sarcoma (RPS) should be managed within specialist sarcoma centres (SSC). There is, however, a paucity of population-based data detailing incidence and outcomes in these patients. Hence, we aimed to evaluate patterns of care among RPS patients in England and compare outcomes for those undergoing surgery in high-volume specialist sarcoma centres (HV-SSC), low-volume SSC (LV-SSC), and non-SSC (N-SSC).
    Methods: Data on patients diagnosed with primary RPS between 2013 and 2018 were extracted from NHS Digital's National Cancer Registration and Analysis Service using the national cancer registration dataset. Diagnostic pathways, treatment, and survival outcomes were compared between HV-SSC, LV-SSC, and N-SSC. Uni- and multivariate analyses were calculated.
    Results: Of 1878 patients diagnosed with RPS, 1120 (60%) underwent surgery within 12 months of diagnosis, with 847 (76%) operated on at SSC; of these, 432 patients (51%) were operated on in HV-SSC, and 415 (49%) in LV-SSC. One- and 5-year estimated overall survival (OS) rates for patients undergoing surgery in N-SSC were 70.6% (95% confidence interval [CI]: 64.8-75.7) and 42.0% (CI: 35.9-47.9), compared to 85.0% (CI: 81.1-88.1) and 51.7% (CI: 46.6-56.6) in LV-SSC (p < 0.01), and 87.4% (CI: 83.9-90.2) and 62.8% (CI: 57.9-67.4) in HV-SSC, (p < 0.01). After adjusting for patient- and treatment-related factors, patients treated in HV-SSC were found to have significantly longer OS than those treated at LV-SSC, with an adjusted hazard ratio of 0.78 (CI: 0.62-0.96, p < 0.05).
    Conclusion: Patients with RPS undergoing surgery in HV-SSC have significantly better survival outcomes than those treated in N-SSC and L-SSC.
    MeSH term(s) Humans ; Sarcoma/surgery ; Retroperitoneal Neoplasms/surgery ; Proportional Hazards Models ; Soft Tissue Neoplasms ; England/epidemiology ; Retrospective Studies ; Survival Rate
    Language English
    Publishing date 2023-04-17
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 82061-1
    ISSN 1879-0852 ; 0277-5379 ; 0959-8049 ; 0964-1947
    ISSN (online) 1879-0852
    ISSN 0277-5379 ; 0959-8049 ; 0964-1947
    DOI 10.1016/j.ejca.2023.04.004
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  4. Article ; Online: Cumulative Burden of Postoperative Complications in Patients Undergoing Surgery for Primary Retroperitoneal Sarcoma.

    Tirotta, Fabio / Parente, Alessandro / Hodson, James / Desai, Anant / Almond, L Max / Ford, Samuel J

    Annals of surgical oncology

    2021  Volume 28, Issue 12, Page(s) 7939–7949

    Abstract: Background: Correlations between postoperative complications and oncological outcomes have been reported in several malignancies, but their impact in retroperitoneal sarcoma (RPS) is unclear. Our study aimed to evaluate the association between ... ...

    Abstract Background: Correlations between postoperative complications and oncological outcomes have been reported in several malignancies, but their impact in retroperitoneal sarcoma (RPS) is unclear. Our study aimed to evaluate the association between postoperative complications and prognosis in patients with RPS.
    Methods: Patients undergoing surgery for primary RPS from 2008 to 2019 at a sarcoma center were evaluated. The cumulative burden of postoperative complications was quantified using the Comprehensive Complication Index (CCI), and associations with local recurrence (LR), distant metastases (DM) and overall survival (OS) were assessed.
    Results: Data were available for 191 patients, of whom 160 (82.9%) developed at least one postoperative complication, with a median CCI of 20.9 (interquartile range 8.7-33.5). After postoperative deaths were excluded (n = 3, 1.6%), the remaining patients were divided into those with a CCI of 0-20.9 (n = 97) and > 20.9 (n = 91). Patients with a CCI >20.9 had significantly shorter OS than those with a CCI of 0-20.9 (43.3% vs. 69.5% at 5 years; p = 0.005), and this difference remained significant after multivariable adjustment for patient- and treatment-related factors [hazard ratio (HR) 2.31, 95% confidence interval (CI) 1.30-4.09; p = 0.004]. However, CCI > 20.9 was not found to be a significant independent predictor of either LR (HR 1.30, 95% CI 0.76-2.23; p = 0.333) or DM (HR 1.08, 95% CI 0.61-1.93; p = 0.786).
    Conclusion: Increasing complication burden, as quantified by the CCI, is a significant independent predictor of OS; however, there is no evidence of a significant association with either LR or DM, which may be more related to tumor biological factors.
    MeSH term(s) Humans ; Neoplasm Recurrence, Local ; Postoperative Complications/etiology ; Retroperitoneal Neoplasms/surgery ; Retrospective Studies ; Sarcoma/surgery ; Survival Rate
    Language English
    Publishing date 2021-05-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1200469-8
    ISSN 1534-4681 ; 1068-9265
    ISSN (online) 1534-4681
    ISSN 1068-9265
    DOI 10.1245/s10434-021-10059-1
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  5. Article: Emergency multivisceral resection for spontaneous haemorrhage rupture of huge solid pseudopapillary neoplasm of the pancreas during pregnancy

    Ahmad, Raheel / Baia, Marco / Naumann, David N / Mahmood, Fahad / Tirotta, Fabio / Ford, Samuel / Desai, Anant / Almond, Max

    Journal of surgical case reports

    2022  Volume 2022, Issue 7, Page(s) rjac331

    Abstract: Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare malignancy with a low malignant potential and strong female preponderance. Diagnosis during pregnancy is extraordinary, and management must consider the risks to the mother and foetus of ... ...

    Abstract Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare malignancy with a low malignant potential and strong female preponderance. Diagnosis during pregnancy is extraordinary, and management must consider the risks to the mother and foetus of tumour growth and rupture. A large 35-cm SPN was identified on magnetic resonance imaging (MRI) in a 24-year-old woman at 6 weeks of gestation following presentation with an abdominal mass. Surgery was delayed to allow the foetus to reach as close to term as possible because surveillance MRIs showed incremental mass growth. Emergency c-section was undertaken at 35 weeks of gestation due to persistent tachycardia and suspected haemorrhage into the tumour. A Hb of 70 g/l post-delivery despite four units of RBCs and an albumin of 11 g/l necessitated urgent multivisceral surgery. Surgical resection is the mainstay of treatment for SPN. However, the strategy of choice during pregnancy remains undetermined, with more recent reports delaying surgery until post-partum.
    Language English
    Publishing date 2022-07-25
    Publishing country England
    Document type Case Reports
    ZDB-ID 2580919-2
    ISSN 2042-8812
    ISSN 2042-8812
    DOI 10.1093/jscr/rjac331
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  6. Article ; Online: Overall survival in abdominal wall sarcoma treated with curative intent surgery: A retrospective study from two European referral centres.

    Tattersall, Hannah L / Baia, Marco / Messina, Valentina / Borghi, Alessandra / Tirotta, Fabio / Almond, Max / Desai, Anant / Ford, Samuel J / Gronchi, Alessandro

    Journal of surgical oncology

    2022  Volume 126, Issue 2, Page(s) 365–371

    Abstract: Introduction: Primary abdominal wall sarcomas are rare, heterogeneous tumours. The mainstay of management is surgery, although local recurrences (LR) and distant metastases (DM) are common.: Objectives: Overall survival (OS) and disease-free survival ...

    Abstract Introduction: Primary abdominal wall sarcomas are rare, heterogeneous tumours. The mainstay of management is surgery, although local recurrences (LR) and distant metastases (DM) are common.
    Objectives: Overall survival (OS) and disease-free survival (DFS) were primary outcomes; factors associated with prognosis secondary outcomes.
    Materials and methods: Patients undergoing surgery of primary abdominal wall sarcomas between April 2008 and May 2018 were identified at two referrals centres for sarcoma surgery. Patient demographics, tumour and treatment-related characteristics were recorded and analysed.
    Results: A cohort of 65 patients underwent surgical resection with a median follow-up of 56 months, 5-year OS and DFS were 69% and 71%, respectively. Eleven patients (16.9%) experienced a recurrence event: 6 LR (9.2%), 10 DM (15.4%) and 5 both (7.7%). At univariate analysis, size (p = 0.03), grade (p = 0.001) and depth (p = 0.04) were associated with OS while size (p = 0.02) was associated with DFS. No significant relationship with tumour depth, type of surgery, surgical margin status or neo-/adjuvant treatment was demonstrated.
    Conclusion: Recurrence events are less common following treatment of abdominal wall sarcomas if compared to extremities STSs, but size (≥5 cm), high malignancy grade (FNCLCC 3) and depth are associated with worse OS.
    MeSH term(s) Abdominal Wall/pathology ; Abdominal Wall/surgery ; Humans ; Neoplasm Recurrence, Local/surgery ; Prognosis ; Referral and Consultation ; Retrospective Studies ; Sarcoma/pathology ; Soft Tissue Neoplasms/pathology
    Language English
    Publishing date 2022-03-25
    Publishing country United States
    Document type Journal Article
    ZDB-ID 82063-5
    ISSN 1096-9098 ; 0022-4790
    ISSN (online) 1096-9098
    ISSN 0022-4790
    DOI 10.1002/jso.26867
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  7. Article ; Online: A review of retroperitoneal liposarcoma genomics.

    Tyler, Robert / Wanigasooriya, Kasun / Taniere, Philippe / Almond, Max / Ford, Samuel / Desai, Anant / Beggs, Andrew

    Cancer treatment reviews

    2020  Volume 86, Page(s) 102013

    Abstract: Retroperitoneal liposarcomas are rare tumours that carry a poorer prognosis than their extremity counterparts. Within their subtypes - well differentiated (WDL), dedifferentiated (DDL), myxoid (MLS) and pleomorphic (PLS) - they exhibit a diverse genomic ... ...

    Abstract Retroperitoneal liposarcomas are rare tumours that carry a poorer prognosis than their extremity counterparts. Within their subtypes - well differentiated (WDL), dedifferentiated (DDL), myxoid (MLS) and pleomorphic (PLS) - they exhibit a diverse genomic landscape. With recent advances in next generation sequencing, the number of studies exploring this have greatly increased. The recent literature has deepened our understanding of the hallmark MDM2/CDK4 amplification in WDL/DDL and addressed concerns about toxicity and resistance when targeting this. The FUS-DDIT3 fusion gene remains the primary focus of interest in MLS with additional potential targets described. Whole genome sequencing has driven identification of novel genes and pathways implicated in WDL/DDL outside of the classic 12q13-15 amplicon. Due to their rarity; anatomical location and histologic subtype are infrequently mentioned when reporting the results of these studies. Reports can include non-adipogenic or extremity tumours, making it difficult to draw specific retroperitoneal conclusions. This narrative review aims to provide a summary of retroperitoneal liposarcoma genomics and the implications for therapeutic targeting.
    MeSH term(s) Animals ; Antineoplastic Agents, Alkylating/therapeutic use ; Chromosome Aberrations ; Genomics/methods ; Humans ; Liposarcoma/drug therapy ; Liposarcoma/genetics ; Liposarcoma/metabolism ; Oncogene Proteins, Fusion/genetics ; Phosphatidylinositol 3-Kinases/genetics ; Phosphatidylinositol 3-Kinases/metabolism ; Retroperitoneal Neoplasms/drug therapy ; Retroperitoneal Neoplasms/genetics ; Retroperitoneal Neoplasms/metabolism ; Trabectedin/therapeutic use
    Chemical Substances Antineoplastic Agents, Alkylating ; FUS-DDIT3 fusion protein, human ; Oncogene Proteins, Fusion ; Trabectedin (ID0YZQ2TCP)
    Language English
    Publishing date 2020-03-28
    Publishing country Netherlands
    Document type Journal Article ; Review
    ZDB-ID 125102-8
    ISSN 1532-1967 ; 0305-7372
    ISSN (online) 1532-1967
    ISSN 0305-7372
    DOI 10.1016/j.ctrv.2020.102013
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    Zs.MO 611: Show issues

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  8. Article ; Online: Association between centre volume and allocation to curative surgery and long-term survival for retroperitoneal sarcoma.

    Kamarajah, Sivesh K / Baia, Marco / Naumann, David N / Mahmood, Fahad / Parente, Alessandro / Almond, Max / Tirotta, Fabio / Ford, Samuel J / Dahdaleh, Fadi / Desai, Anant

    BJS open

    2023  Volume 7, Issue 4

    MeSH term(s) Humans ; Retroperitoneal Neoplasms/surgery ; Retrospective Studies ; Sarcoma/surgery
    Language English
    Publishing date 2023-07-26
    Publishing country England
    Document type Journal Article
    ISSN 2474-9842
    ISSN (online) 2474-9842
    DOI 10.1093/bjsopen/zrad059
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  9. Article ; Online: Risk Factors for the Development of Early Recurrence in Patients with Primary Retroperitoneal Sarcoma.

    Tirotta, Fabio / Fadel, Michael G / Baia, Marco / Parente, Alessandro / Messina, Valentina / Bassett, Paul / Almond, L Max / Ford, Samuel J / Desai, Anant / van Houdt, Winan J / Strauss, Dirk C

    Annals of surgical oncology

    2023  Volume 30, Issue 11, Page(s) 6875–6883

    Abstract: Background: Disease recurrence after retroperitoneal sarcoma (RPS) surgery is common, and resection may offer no benefit for patients who experience recurrence early. This study examined the incidence of early recurrence (EREC) in RPS patients, and the ... ...

    Abstract Background: Disease recurrence after retroperitoneal sarcoma (RPS) surgery is common, and resection may offer no benefit for patients who experience recurrence early. This study examined the incidence of early recurrence (EREC) in RPS patients, and the association between EREC and prognosis, aiming to identify the factors associated with EREC.
    Methods: Patients undergoing surgery for primary RPS from 2008 to 2019 at two tertiary RPS centers were analyzed. The study defined EREC as any evidence of local recurrence and/or distant metastases on the CT scan up to 6 months after surgery. Overall survival (OS) was calculated using the Kaplan-Meier method. A multivariable analysis was performed to identify independent predictors of EREC.
    Results: Of the 692 patients who underwent surgery during the study period, 657 were included in the analysis. Sixty-five of these patients (9.9%; 95% confidence interval [CI], 7.7-12.4%) developed EREC. Five-year OS was 3% for the patients with EREC versus 76% for those without EREC (p < 0.001). Patient characteristics were compared between the EREC and non-EREC patients, and EREC was found to be significantly associated with Eastern Cooperative Oncology Group (ECOG) performance status (p = 0.006), tumor histology (p = 0.002), tumor grading (p < 0.001), radiotherapy (p = 0.04), and postoperative complications measured as a comprehensive complications index value (p = 0.003). However, the only significant independent predictor of EREC in the multivariable analysis was grade 3 tumors, with an odds ratio of 14.8 (95% CI, 4.44-49.2; p < 0.001).
    Conclusion: Early recurrence is associated with a poor prognosis, and a high tumor grade is an independent predictor for the development of EREC. Patients with EREC may benefit the most from new therapeutic options such as neoadjuvant chemotherapy.
    MeSH term(s) Humans ; Neoplasm Recurrence, Local ; Sarcoma/pathology ; Retroperitoneal Neoplasms/pathology ; Retroperitoneal Space/pathology ; Soft Tissue Neoplasms ; Risk Factors ; Retrospective Studies
    Language English
    Publishing date 2023-07-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1200469-8
    ISSN 1534-4681 ; 1068-9265
    ISSN (online) 1534-4681
    ISSN 1068-9265
    DOI 10.1245/s10434-023-13754-3
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  10. Article ; Online: Perioperative blood transfusion is not an independent predictor for worse outcomes in retroperitoneal sarcoma surgery.

    Wong, Boaz / Apte, Sameer S / Tirotta, Fabio / Parente, Alessandro / Mathieu, Johanne / Ford, Sam J / Desai, Anant / Almond, Max / Nessim, Carolyn

    European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

    2021  Volume 47, Issue 7, Page(s) 1763–1770

    Abstract: Background: Surgery for retroperitoneal soft tissue sarcoma (RPS) is technically challenging, often requiring perioperative red blood cell transfusion (PBT). In other cancers, controversy exists regarding the association of PBT and oncologic outcomes. ... ...

    Abstract Background: Surgery for retroperitoneal soft tissue sarcoma (RPS) is technically challenging, often requiring perioperative red blood cell transfusion (PBT). In other cancers, controversy exists regarding the association of PBT and oncologic outcomes. No study has assessed this association in primary RPS, or identified factors associated with PBT.
    Methods: Data was collected on all resected primary RPS between 2006 and 2020 at The Ottawa Hospital (Canada) and University Hospital Birmingham (United Kingdom). 'PBT' denotes transfusion given one week before surgery until discharge. Multivariable regression (MVA) identified clinicopathologic factors associated with PBT and assessed PBT association with oncologic outcomes. Surgical complexity was measured using resected organ score (ROS) and patterns of resection.
    Results: 192 patients were included with 98 (50.8%) receiving PBT. Median follow-up was 38.2 months. High tumour grade (OR 2.20, P = 0.048), preoperative anemia (OR 2.78, P = 0.020), blood loss >1000 mL (OR 4.89, P = 0.004) and ROS >2 (OR 2.29, P = 0.026) were associated with PBT on MVA. A direct linear relationship was observed between higher ROS and increasing units of PBT (β = 0.586, P = 0.038). Increasingly complex patterns of resection were associated with increasing odds of PBT. PBT was associated with severe post-operative complications (P = 0.008) on MVA. Univariable association between PBT and 5-year disease-free or overall survival was lost upon MVA.
    Conclusions: Surgical complexity and high tumour grade are potentially related to PBT. Oncologic outcomes are not predicted by PBT but are better explained by tumour grade which subsequently may increase surgical complexity. Strategies to reduce PBT should be considered in primary RPS patients.
    MeSH term(s) Blood Loss, Surgical ; Blood Transfusion/statistics & numerical data ; England ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Grading ; Ontario ; Perioperative Care ; Postoperative Complications ; Prognosis ; Retroperitoneal Neoplasms/surgery ; Retrospective Studies ; Risk Factors ; Sarcoma/surgery
    Language English
    Publishing date 2021-01-13
    Publishing country England
    Document type Journal Article ; Multicenter Study
    ZDB-ID 632519-1
    ISSN 1532-2157 ; 0748-7983
    ISSN (online) 1532-2157
    ISSN 0748-7983
    DOI 10.1016/j.ejso.2021.01.007
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    Zs.MO 549: Show issues

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