Variations in surgical strategies and treatment allocation for retroperitoneal sarcomas across German-speaking sarcoma centres.
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.
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.
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.
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.
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.
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.
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
Albertsmeier Albertsmeier, Tiefes Tiefes, Tirotta Tirotta, Bauer Bauer, Lindner Lindner, Di Gioia Di Gioia, Schmidt-Hegemann Schmidt-Hegemann, Kunz Kunz, Knösel Knösel, Pink Pink, Duprée Duprée, Kaths Kaths, Hamacher Hamacher, Fechner Fechner, Grützmann Grützmann, Semrau Semrau, Zwirner Zwirner, Schwarzbach Schwarzbach, Ardelt Ardelt, Engerer Engerer, Kirchberg Kirchberg, Bösch Bösch, Steinbach Steinbach, Schiffmann Schiffmann, Maguire Maguire, Gaidzik Gaidzik, Wiegering Wiegering, Lock Lock, Kessler Kessler, Rau Rau, Engel Engel, Hettler Hettler, Breden Breden, Szkandera Szkandera, Wilhelm Wilhelm, Werner Werner, Jakob Jakob,
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