Editorial: Advances in surgical management of abdominal and retroperitoneal sarcoma: where do we stand, and where do we go?

The article series on “Advances in Surgical management of abdominal and retroperitoneal sarcoma” describes real-world clinical problems, current challenges, and new management options of sarcomas in these anatomical locations. Examples of real-world clinical problems in the article series are the occurrence of sarcoma types at uncommon locations, and the occurrence of very rare sarcoma types, like primary osteosarcoma of the kidney (Yu et al.), and retroperitoneal undifferentiated pleomorphic sarcoma (Chen et al.). Another frequently-faced problem is a very large tumor-size at presentation. Hence, surgical treatment requires an extensive and major surgical procedure, and sometimes an alternative surgical approach. An example of this in the article series is a thoracotomy for a giant retroperitoneal tumor with diaphragmatic hernia (Hu et al.). In addition, patients happen to present with metastatic disease and new non-surgical treatment options need to be applied. An example of this in the article series is PD-1 inhibitor treatment combined with chemotherapy for metastatic follicular dendritic cell sarcoma of the spleen (Li et al.). Furthermore, a major problem in clinical practice is the very high risk of recurrence after surgical resection of retroperitoneal liposarcoma as reported in two articles in the series (Gao et al., Wang et al.). New treatment strategies are urgently required to reduce the recurrence risk of retroperitoneal sarcomas. These strategies may include more precise surgery, more extensive surgery, (neo)adjuvant chemo and radiation therapy, and other new treatment options. One article in the series reports on the results of preoperative radiotherapy for retroperitoneal liposarcoma, showing that radiotherapy is well-tolerated, though an increase in postoperative blood transfusions and intensive care stay was observed (Jo et al.). However, no effect on local recurrence and survival was observed, which is in accordance with the randomised STRASS-1 trial