RPS: what is accepted/a standard• LRFS/OS are better when the patient is managed in a

specialized center

• Percutaneous retroperitoneal core biopsy to confirm diagnosis/discuss neo adjuvant treatment/adapt extent of resection (except in typical case DD+WD LPS outside a trial)

• No open/laparoscopic biopsy/frozen section = peritoneal contamination/unhelpful/risks of mistakes

• Most of the wrong surgeries are due to tumor left behind (bad analysis of imaging)/piecemeal resections

• Primary en-bloc complete resection with uninvolved adjacent organs (with a balance with expected morbidity) to maximize the chances of negative margins to be considered on an individualized basis

Technical Considerations in Surgery For Retroperitoneal Sarcomas. Position paper from e-SURGE, a masterclass in sarcoma surgery, and EORTC - STBSGBonvalot S, Raut CP, Pollock RE , Rutkowski P, Strauss DC, Hayes AJ, Van Coevorden F, Fiore M, Stoeckle E, Hohenberger P and Gronchi A . Ann Surg Oncol 2012

RPS: what is not a standard or under investigation

• Neo-adjuvant chemotherapy in locally advanced RPS to render them resectable by shrinkage

• IORT and post operative radiotherapy have no proven value

• Adjuvant chemotherapy after R0/R1 is limited benefit

• EORTC randomized protocol 62092-22092 « STRASS » is testing the role of preop radiotherapy 50.4 gy/surgery alone

(oct 2013: 65pts/256)

International collaboration is necessary (prospective trials, registry)