{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T11:11:46Z","timestamp":1783077106469,"version":"3.54.6"},"reference-count":31,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T00:00:00Z","timestamp":1748304000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: RPS are rare tumors requiring complex surgery. The impact of postoperative complications on long-term outcomes is still debated. This study aimed to identify predictors of severe complications and assess their influence on overall survival (OS) and disease-free survival (DFS). Methods: We retrospectively analyzed 61 patients who underwent curative surgery for primary RPS between 2013 and 2023 at a tertiary cancer center. Patients with pelvic or recurrent sarcomas were excluded. Severe complications were defined as Clavien\u2013Dindo (CD) grade \u2265 3A. Cox regression and Fine\u2013Gray competing risk models were used for OS and DFS, respectively. Sarculator and P-POSSUM scores were included in multivariable models. Results: Severe complications occurred in 14.8% of patients; 30-day mortality was 1.6%. Predictive factors for complications included longer operative time, gastric resection, intraoperative complications, and transfusions. In multivariable analysis, Sarculator was significantly associated with both DFS (HR 0.97; p = 0.004) and OS (HR 0.97; p = 0.008). The P-POSSUM mortality score predicted OS (HR 1.12; p = 0.002). Severe complications were not independently associated with DFS or OS. Conclusions: In this cohort, severe complications did not impact long-term oncological outcomes. Prognostic tools such as Sarculator and P-POSSUM may enhance risk stratification in RPS surgery. Prospective validation is warranted.<\/jats:p>","DOI":"10.3390\/cancers17111787","type":"journal-article","created":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T09:29:36Z","timestamp":1748338176000},"page":"1787","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of Severe Postoperative Complications and P-POSSUM Score on Oncological Outcomes in Primary Retroperitoneal Sarcoma: Insights from a Tertiary Cancer Center"],"prefix":"10.3390","volume":"17","author":[{"given":"Carlo","family":"Abatini","sequence":"first","affiliation":[{"name":"Surgical Unit of Peritoneum and Retroperitoneum Surgery, Fondazione Policlinico Universitario Agostino, Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Barberis","sequence":"additional","affiliation":[{"name":"General Surgery Department, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Lodoli","sequence":"additional","affiliation":[{"name":"Surgical Unit of Peritoneum and Retroperitoneum Surgery, Fondazione Policlinico Universitario Agostino, Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8040-2231","authenticated-orcid":false,"given":"Federica","family":"Ferracci","sequence":"additional","affiliation":[{"name":"Surgical Unit of Peritoneum and Retroperitoneum Surgery, Fondazione Policlinico Universitario Agostino, Gemelli IRCCS, 00168 Rome, Italy"},{"name":"General Surgery Department, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9819-105X","authenticated-orcid":false,"given":"Enrico","family":"De Lorenzis","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Fondazione Policlinico Universitario Agostino, Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgio","family":"D\u2019Annibale","sequence":"additional","affiliation":[{"name":"General Surgery Department, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Aulicino","sequence":"additional","affiliation":[{"name":"General Surgery Department, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michela","family":"Quirino","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Fondazione Policlinico Universitario Agostino, Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3796-3877","authenticated-orcid":false,"given":"Mariantonietta","family":"Di Salvatore","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology, Fondazione Policlinico Universitario Agostino, Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Alfieri","sequence":"additional","affiliation":[{"name":"General Surgery Department, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"},{"name":"Division of Digestive Surgery, Fondazione Policlinico Universitario Agostino, Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Pacelli","sequence":"additional","affiliation":[{"name":"Surgical Unit of Peritoneum and Retroperitoneum Surgery, Fondazione Policlinico Universitario Agostino, Gemelli IRCCS, 00168 Rome, Italy"},{"name":"General Surgery Department, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Santullo","sequence":"additional","affiliation":[{"name":"Surgical Unit of Peritoneum and Retroperitoneum Surgery, Fondazione Policlinico Universitario Agostino, Gemelli IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.canep.2019.02.012","article-title":"Soft tissue sarcoma in Italy: From epidemiological data to clinical networking to improve patient care and outcomes","volume":"59","author":"Trama","year":"2019","journal-title":"Cancer Epidemiol."},{"key":"ref_2","unstructured":"AIRTUM (2024, February 02). I Numeri del Cancro in Italia. Available online: https:\/\/www.aiom.it\/i-numeri-del-cancro-in-italia\/."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1002\/jso.24919","article-title":"Current principles of surgery for retroperitoneal sarcomas","volume":"117","author":"Fairweather","year":"2018","journal-title":"J. Surg. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.1097\/SLA.0000000000001447","article-title":"Variability in Patterns of Recurrence After Resection of Primary Retroperitoneal Sarcoma","volume":"263","author":"Gronchi","year":"2016","journal-title":"Ann. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1016\/S1470-2045(20)30446-0","article-title":"Preoperative radiotherapy plus surgery versus surgery alone for retroperitoneal sarcoma: STRASS trial","volume":"21","author":"Bonvalot","year":"2020","journal-title":"Lancet Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1507","DOI":"10.1245\/s10434-010-1057-5","article-title":"Aggressive surgery in retroperitoneal soft tissue sarcoma carried out at high-volume centers is safe and is associated with improved local control","volume":"17","author":"Bonvalot","year":"2010","journal-title":"Ann. Surg. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1002\/jso.25649","article-title":"Morbidity, mortality and temporal trends in the surgical management of retroperitoneal sarcoma: An ACS-NSQIP follow-up analysis","volume":"120","author":"Judge","year":"2019","journal-title":"J. Surg. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2693","DOI":"10.1245\/s10434-020-09179-x","article-title":"Severe postoperative complications are associated with impaired survival in primary but not in recurrent retroperitoneal sarcoma","volume":"28","author":"Nizri","year":"2021","journal-title":"Ann. Surg. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"7939","DOI":"10.1245\/s10434-021-10059-1","article-title":"Cumulative burden of postoperative complications in patients undergoing surgery for primary retroperitoneal sarcoma","volume":"28","author":"Tirotta","year":"2021","journal-title":"Ann. Surg. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1097\/SLA.0000000000006098","article-title":"New Sarculator prognostic nomograms for patients with primary retroperitoneal sarcoma: Case volume does matter","volume":"279","author":"Callegaro","year":"2023","journal-title":"Ann. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.asjsur.2015.07.004","article-title":"Evaluation of the POSSUM, p-POSSUM, o-POSSUM, and APACHE II scoring systems in predicting postoperative mortality and morbidity in gastric cancer patients","volume":"40","author":"Hong","year":"2017","journal-title":"Asian J. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"7873","DOI":"10.1245\/s10434-021-09654-z","article-title":"Management of primary retroperitoneal sarcoma (RPS) in the adult: An updated consensus approach from the Transatlantic Australasian RPS Working Group","volume":"28","author":"Swallow","year":"2021","journal-title":"Ann. Surg. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1007\/s10353-018-0551-z","article-title":"Experiences with the standardized classification of surgical complications (Clavien-Dindo) in general surgery patients","volume":"50","author":"Bolliger","year":"2018","journal-title":"Eur. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1097\/SLA.0000000000002132","article-title":"The Comprehensive Complication Index (CCI\u00ae): Added value and clinical perspectives 3 years \u2018down the line\u2019","volume":"265","author":"Clavien","year":"2017","journal-title":"Ann. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1046\/j.1365-2168.1998.00840.x","article-title":"POSSUM and Portsmouth POSSUM for predicting mortality","volume":"85","author":"Prytherch","year":"1998","journal-title":"Br. J. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"7957","DOI":"10.1245\/s10434-024-15861-1","article-title":"Surgical outcome in retroperitoneal sarcoma surgery: Accuracy of P-POSSUM, ACS-NSQIP, and Inflammatory Biomarkers Prognostic Index (IBPI) risk-calculators for prediction of severe and overall morbidity","volume":"31","author":"Angelucci","year":"2024","journal-title":"Ann. Surg. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.jvs.2006.03.001","article-title":"Clinical results of surgery for retroperitoneal sarcoma with major blood vessel involvement","volume":"44","author":"Schwarzbach","year":"2006","journal-title":"J. Vasc. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"zrad075","DOI":"10.1093\/bjsopen\/zrad075","article-title":"Association of perioperative allogeneic blood transfusions and long-term outcomes following radical surgery for gastric and colorectal cancers: Systematic review and meta-analysis of propensity-adjusted observational studies","volume":"7","author":"Zhang","year":"2023","journal-title":"BJS Open"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Sim\u00f5es, C.M., Carmona, M.J.C., Hajjar, L.A., Vincent, J.L., Landoni, G., Belletti, A., Vieira, J.E., de Almeida, J.P., de Almeida, E.P., and Ribeiro, U. (2018). Predictors of major complications after elective abdominal surgery in cancer patients. BMC Anesthesiol., 18.","DOI":"10.1186\/s12871-018-0516-6"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"119","DOI":"10.4103\/ssj.ssj_28_19","article-title":"Predictors of postoperative complications in retroperitoneal sarcoma surgery","volume":"7","author":"Nassif","year":"2019","journal-title":"Saudi Surg. J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"492","DOI":"10.3390\/curroncol30010039","article-title":"Morbidity and mortality after surgery for retroperitoneal sarcoma","volume":"30","author":"Ruff","year":"2022","journal-title":"Curr. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1245\/s10434-014-4130-7","article-title":"Personalizing the approach to retroperitoneal soft tissue sarcoma: Histology-specific patterns of failure and postrelapse outcome after primary extended resection","volume":"22","author":"Gronchi","year":"2015","journal-title":"Ann. Surg. Oncol."},{"key":"ref_23","first-page":"2","article-title":"Surgical role, prognostic factors, and outcome prediction in primary retroperitoneal sarcoma: A prospective large cohort study","volume":"40","author":"Baiomy","year":"2021","journal-title":"Egypt. J. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1002\/jso.26071","article-title":"Retroperitoneal sarcoma perioperative risk stratification: A United States Sarcoma Collaborative evaluation of the ACS-NSQIP risk calculator","volume":"122","author":"Schwartz","year":"2020","journal-title":"J. Surg. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"115120","DOI":"10.1016\/j.ejca.2024.115120","article-title":"Radiomic features of primary retroperitoneal sarcomas: A prognostic study","volume":"213","author":"Pasquali","year":"2024","journal-title":"Eur. J. Cancer"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1016\/j.asjsur.2020.01.005","article-title":"Applicability of the Sarculator and MSKCC nomograms to retroperitoneal sarcoma prognostication in an Asian tertiary center","volume":"43","author":"Wong","year":"2020","journal-title":"Asian J. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1007\/s00423-024-03405-w","article-title":"Survival and prognostic factors of primary retroperitoneal sarcomas after surgery: A single-center experience","volume":"409","author":"Zhao","year":"2024","journal-title":"Langenbecks Arch. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"104435","DOI":"10.1016\/j.esmoop.2025.104435","article-title":"122P Risk stratification in soft tissue sarcoma: A single-center experience using Sarculator","volume":"10","author":"Schenone","year":"2025","journal-title":"ESMO Open"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1016\/j.ejso.2022.06.003","article-title":"Pelvic soft tissue sarcomas","volume":"49","author":"Dumitra","year":"2023","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1016\/j.ejso.2021.12.010","article-title":"Measuring the impact of complications after surgery for retroperitoneal sarcoma: Is comprehensive complication index better than Clavien-Dindo Classification?","volume":"48","author":"Ruspi","year":"2022","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1002\/jso.26612","article-title":"Comparison of comprehensive complication index and Clavien\u2013Dindo classification in patients with retroperitoneal sarcoma","volume":"124","author":"Tirotta","year":"2021","journal-title":"J. Surg. Oncol."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/11\/1787\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:41:19Z","timestamp":1760031679000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/17\/11\/1787"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,27]]},"references-count":31,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["cancers17111787"],"URL":"https:\/\/doi.org\/10.3390\/cancers17111787","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,27]]}}}