Impact of travel distance on oncologic outcomes after curative-intent surgery for retroperitoneal sarcoma.

Abstract

e23575 Background: Retroperitoneal sarcoma (RPS) is associated with high rates of recurrence despite optimal surgical management. Although centralization of care in high-volume referral centers is widely recommended, geographic barriers could potentially affect surveillance, early detection of recurrence, and survival. We aimed to evaluate whether travel distance from a patient’s residence to the treating center influences oncologic outcomes after curative-intent surgery for RPS, accounting for histologic heterogeneity. Methods: We conducted a retrospective cohort study of patients with primary RPS who underwent curative-intent resection. Travel distance was defined as the average distance from the patient’s main residence to the treating hospital and dichotomized at 50 km (≤50 km vs > 50 km). Histology was classified according to WHO criteria and grouped as well-differentiated liposarcoma (WDLPS), dedifferentiated liposarcoma (DDLPS), leiomyosarcoma (LMS), and other high-grade sarcomas. Patients with unknown vital status were considered alive and censored at last follow-up. Primary endpoints were recurrence-free survival (RFS) and overall survival (OS), estimated using the Kaplan–Meier method and compared with log-rank tests. Secondary endpoints included documented recurrence rates. Results: Among 78 patients, 33 (42.3%) lived ≤50 km from the treating center (median 27 km) and 45 (57.7%) lived > 50 km away (median 129 km). Liposarcoma predominated, with WDLPS and DDLPS accounting for 71.7% of cases; LMS represented 13% and other high-grade sarcomas 15%, such that more than half of the cohort had high-grade disease. Recurrence rates were similar between groups (42.4% for ≤50 km vs 40.0% for > 50 km, p = NS), as were mortality rates (18.2% vs 11.1%, p = 0.51). Among 76 evaluable patients, median RFS was 54.4 months in the ≤50 km group and 32.9 months in the > 50 km group, without significant difference (p = 0.95). Three- and five-year RFS were 57.1% and 40.4% versus 49.9% and 46.1%, respectively. Median OS was not reached in either cohort; three- and five-year OS were 89.7% and 89.7% for ≤50 km versus 88.6% and 83.4% for > 50 km (p = 0.76). Conclusions: In patients undergoing curative-intent surgery for RPS, a travel distance greater than 50 km was not associated with increased recurrence risk or inferior RFS or OS, even in a population dominated by aggressive histologic subtypes such as DDLPS and LMS. These findings support the safety and effectiveness of centralized sarcoma care models and highlight that intrinsic tumor biology, rather than geographic proximity, remains the principal determinant of oncologic outcomes in retroperitoneal sarcoma.