Variations in surgical strategies and treatment allocation for retroperitoneal sarcomas across German-speaking sarcoma centres

Albertsmeier M, Tiefes A, Tirotta F, Bauer A, Lindner LH, Di Gioia D, Schmidt-Hegemann NS, Kunz WG, Knösel T, Pink D, Duprée A, Kaths M, Hamacher R, Fechner K, Grützmann R, Semrau S, Zwirner U, Schwarzbach M, Ardelt M, Engerer C, Kirchberg J, Bösch F, Steinbach M, Schiffmann L, Maguire N, Gaidzik VI, Wiegering A, Lock J, Kessler T, Rau D, Engel L, Hettler M, Breden S, Szkandera J, Wilhelm A, Werner J, Jakob J, Kettelhack C, Krasniqi F, Gross M, Harder D, Öllinger R, Flörcken A, Zips D, Schäfer FM, Ghani S, Krempien R, Kakkassery M, Wagner M, Richter S, Rehm M, Plodeck V, Denz A, Meidenbauer N, Melzer K, Treckmann J, Bauer S, Fischedick G, Milosevic A, Ahrens M, Imhoff D, Scholtz JE, Scholten F, Schulz-Ertner D, Müller-Schimpfle M, Szuszies C, Guhlich M, Amir Hosseini AS, Hau HM, Moustafa-Hubmer D, Igrec J, Schewe S, Priemel M, Striefler J, Krug D, Sieben P, Well L, Ivanyi P, Abaci A, von Falck C, Al-Saeedi M, Egerer G, Apostolidis L, Seidensaal K, Sedlaczek O, Schrenk KG, Mäurer M, Malouhi A, Tuchscherer A, Ferdinandus S, Rauen P, Menge F, Kasper B, Simeonova A, Knebel C, Hecker J, Lörsch A, Diehl C, Mansoorian S, Reidler P, Hoepfner B, Augustin M, Spielau-Romer C, Pangritz S, Piso P, Blaj S, Hübner G, Kappl P, Strohäker J, Deinzer CK, Potkrajcic V, Winkelmann MT, Wittau M, Welte B, Breitruck J, Kunzmann V, Zimmermann M, Heidemeier A (2026)

Publication Type: Journal article

Publication year: 2026

Journal

Book Volume: 52

Article Number: 111999

Journal Issue: 10

DOI: 10.1016/j.ejso.2026.111999

Abstract

Introduction: Retroperitoneal sarcomas (RPS) require multidisciplinary decision-making. Following centre certification and the publication of national guidelines in German-speaking countries, the consistency and reliability of multidisciplinary team (MDT) recommendations for RPS remain unclear. Materials and methods: In this multi-centre study, 24 German-speaking sarcoma MDTs independently reviewed pre-treatment imaging and clinical information from 20 anonymised primary RPS cases. Centres provided standardised assessments of resectability, surgical strategy, and treatment allocation. Inter-centre agreement was quantified using percentage agreement with the per-case consensus and Krippendorff's alpha statistic (α), interpreted using established reference values. Results: Review of the 20 cases resulted in up to 480 MDT assessments for each item. Across 468 assessments, 411 (88%) rated the tumour as resectable and 57 (12%) as non-resectable. Centre-level agreement with the per-case consensus was 90.2%, with fair inter-centre reliability (α = 0.21). Agreement was lower in large tumours (>20 cm: 79.6%, α = 0.27) compared with smaller tumours. Agreement on surgical strategy was 65.9% (284/431; α = 0.21), with marked variability in the extent of resection and the use of compartmental versus organ-sparing approaches. Agreement on treatment allocation was 75.6% (350/463; α = 0.24) with centres pursuing different subtype-specific treatment concepts. In 8 of 20 cases, at least one centre recommended palliative treatment while others proposed a potentially curative approach. Conclusion: The majority of patients were offered curative treatment options in almost all centres. Substantial variability was observed in histology-specific surgical strategies and treatment allocation. These findings indicate that centre-level interpretive frameworks substantially influence MDT recommendations. Strengthening cross-centre collaboration and refining histology-specific guidance may improve consistency in RPS care without undermining expert judgment.

Authors with CRIS profile

Involved external institutions

Krankenhaus Barmherzige Brüder Germany (DE) Universitätsklinikum Ulm Germany (DE) Universitätsklinikum Würzburg Germany (DE) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) Klinikum der Universität München (LMU Klinikum) Germany (DE) Universitätsklinikum Münster Germany (DE) Klinikum Nürnberg Germany (DE) Nationales Centrum für Tumorerkrankungen (NCT) Germany (DE) Universitätsklinikum Essen Germany (DE) Universitätsklinikum Frankfurt am Main (KGU) Germany (DE) Universitätsklinikum Göttingen Germany (DE) Medizinische Universität Graz Austria (AT) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Universitätsklinikum Köln Germany (DE) Ruprecht-Karls-Universität Heidelberg Germany (DE) Universitätsklinikum Jena Germany (DE) Universitätsklinikum Mannheim / University Medical Centre Mannheim (Universitätsmedizin Mannheim) Germany (DE) Klinikum rechts der Isar Germany (DE) University Hospitals Birmingham NHS Foundation Trust United Kingdom (GB) HELIOS Kliniken Germany (DE) Charité - Universitätsmedizin Berlin Germany (DE) Ludwig-Maximilians-Universität (LMU) Germany (DE) Universitätsspital Basel Switzerland (CH) Agaplesion Markus Krankenhaus Germany (DE) Universitätsklinikum Tübingen Germany (DE)

How to cite

APA:

Albertsmeier, M., Tiefes, A., Tirotta, F., Bauer, A., Lindner, L.H., Di Gioia, D.,... Heidemeier, A. (2026). Variations in surgical strategies and treatment allocation for retroperitoneal sarcomas across German-speaking sarcoma centres. European Journal of Surgical Oncology, 52(10). https://doi.org/10.1016/j.ejso.2026.111999

MLA:

Albertsmeier, Markus, et al. "Variations in surgical strategies and treatment allocation for retroperitoneal sarcomas across German-speaking sarcoma centres." European Journal of Surgical Oncology 52.10 (2026).

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