Treatment Pathways and Prognosis in Advanced Sarcoma with Peritoneal Sarcomatosis

SIMPLE SUMMARY: Presentation of sarcoma inside the peritoneal cavity is a rare finding to begin with. In such a rare incidence, there are a multitude of sarcoma subtypes that can be identified, with each of these subtypes presenting with different characteristics in terms of prognosis and treatment options. Considering these factors and the resulting lack of strong data to guide treatment plans, this study aims to share our experiences with cases of peritoneal sarcomatosis to increase the knowledge about possible options and outcomes. We report on 19 cases of surgery in patients with peritoneal sarcomatosis, ranging from palliative procedures to major multivisceral resections, and highlight their course of disease, treatment, and outcome. Hereby, we aspire to increase the cumulative experience with challenging cases like these and support a more informed tailoring of treatment plans for future cases to come. ABSTRACT: Sarcomas represent a heterogeneous group of mesenchymal malignancies that most commonly occur in the extremities, retroperitoneum, and head and neck. Intra-abdominal manifestations are rare and prove particularly difficult to treat when peritoneal sarcomatosis is present. Because of the overall poor prognosis of the disease, a tailored approach to surgical management is essential to achieve satisfactory outcomes with limited morbidity. We present the perioperative and long-term outcomes of 19 cases of sarcoma with peritoneal sarcomatosis treated surgically at our hospital. Treatment pathways were reviewed and clinical follow-up was performed. Patient characteristics, medical history, tumor subtype, surgical approach, hospital stay, complications, follow-up, and overall survival (OS) were assessed. Our patients were 9 women and 10 men with a median age of 45.9 years (18–88) and a median survival of 30 months (0–200). In most cases, peritoneal sarcomatosis was either discovered during surgery or the procedure was performed with palliative intent from the beginning. The surgical approach in these cases is very heterogeneous and should consider a variety of factors to tailor an approach for each patient. Sharing our experiences will help to increase knowledge about this rare disease and provide insight into the management of future cases.