Surgery is the key treatment in retroperitoneal sarcoma (RPS), as completeness of resection is the most important prognostic factor related to treatment. Compartmental surgery/frontline extended approach is based on soft-tissue sarcoma surgical principles, and involves resecting adjacent viscera to achieve a wide negative margin. This extended approach is associated with improved local control and survival. This surgery must be tailored to tumor histology, tumor localization, and patient performance status. We herein present a review of compartmental surgery principles, covering the oncological and technical basis, and describing the tailored approach to each tumor subtype and localization in the retroperitoneum.

Background/Objectives: To review the problem of diagnostic delay in soft tissue sarcomas with the aim of identifying its causes and consequences, understanding how to clinically suspect and refer them, and evaluating the main limitations of the referral guidelines already in use. Methods: A systematic review of the available literature was performed, focusing on the theoretical framework, the elements and time intervals to be considered, causes and consequences, “red flag” symptoms/signs, the main referral guidelines in use, their results, and the methods used to avoid excessive referrals. Results: Diagnostic delay in soft tissue sarcomas is a frequent event that is poorly characterized and has important consequences, including prognostic, medico-legal and psycho-social effects. The common denominator is the lack of knowledge and awareness. Several referral guidelines have been described, and most of them are based on clinical data. Their results have been disappointing. Thus, it is necessary to implement new methods to improve their results and avoid the overload of pre-referral imaging systems, sarcoma diagnostic triage meetings, and telemedicine systems. Conclusions: Sarcoma units and health system leaders need to study this issue to determine the extent of the problem and its causes. Without this information, it is almost impossible to properly address the problem and take corrective actions. Early referral of suspected soft tissue sarcoma lesions, although desirable, is a complex issue due to the non-specificity of the symptoms. Existing clinical referral guidelines need to be modified to improve detection and conversion rates.

PURPOSE: To better understand immigration disparities among a Spanish Early-Onset Colorectal Cancer (SECOC) subset, according to the country of origin. PATIENTS AND METHODS: We selected 250 consecutive participants from the SECOC consortium. Data on baseline patient and tumor characteristics, family history of colorectal cancer (CRC), and follow-up were collected. The presence of mismatch repair deficiency was also assessed. Special data regarding country of origin, time of stay in Spain in case of other different country, and a 10-year cutoff that specifies the obtaining of Spanish nationality defined the variables of interest for comparison. RESULTS: Seventy-five percent of patients with early-onset CRC (EOCRC) (188) were born in Spain, whereas the other 25% were born outside of Spain. The mean time of living in Spain until the EOCRC diagnosis was 16.5 years. Comparatively, most of the analyzed features showed equivalent proportions between cohorts. Only Spanish patients appeared to have more familial cancer component in first degree in general (32.3%; P = .01), compared with non-Spaniards, which showed a predominant sporadic component (56.4%; P < .001). Among immigrants, those patients living in Spain before CRC diagnosis ≤10 years were younger at diagnosis (39.1 v 42.5), more frequently male (77.8 v 47.7), were in more advanced stages (88.8% diagnosed at stage III and IV [ P = .01]), and had a worse prognosis regarding recurrence rates (29.4% v 6.3%). CONCLUSION: Although there were few differences between Spanish and non-Spanish EOCRC, the most remarkable difference was that linked with the situation of those immigrants who have recently arrived in Spain, in relation to their lower health coverage, which could be associated with the delay in the diagnosis and their subsequent worse prognosis.

Liver metastases from soft tissue sarcoma (STS) (excluding gastrointestinal stromal tumors) are rare and more commonly arise from retroperitoneal and intra-abdominal primary sites. Chemotherapy remains the mainstay of treatment for disseminated disease, but its effectiveness is limited and patients typically have a dismal prognosis with short survival. However, when metastases are confined to the liver (without pulmonary involvement), some patients may benefit from local techniques, either surgical or nonsurgical, that can provide long periods of disease-free survival. Due to the rarity of STS, especially with liver metastases, and the heterogeneity of histologies and biological behavior, there is a lack of standardized treatment guidelines and universally accepted criteria for this specific setting. To fill this gap, a multidisciplinary working group of experts in sarcoma and liver surgery reviewed the literature and available evidence and developed a set of clinical recommendations to be voted and discussed in the I Ibero-American Consensus on the Management of Metastatic Sarcoma, held at the III Spanish-Portuguese Update Meeting on the Treatment of Sarcomas in May 2024. Herein, the voting results of this meeting and the resulting consensus recommendations are presented, and their applicability, strengths, and limitations are discussed.

Introducción y objetivo:La infección por coronavirus (COVID-19) en pacientes intervenidos es causa de importante mortalidad postoperatoria, aunque su incidencia es variable. El objetivo primario fue evaluar la incidencia de COVID-19 en los pacientes intervenidos en nuestro Servicio de Cirugía General y Digestiva, durante el máximo impacto de la pandemia en España. El objetivo secundario fue evaluar la mortalidad perioperatoria y determinar los factores de riesgo para la infección por COVID-19.Material y métodos:Estudio observacional retrospectivo de pacientes consecutivos sometidos a Cirugía General y Digestiva con ingreso superior a 24 horas, del 1 de febrero de 2020 al 30 de abril de 2020 en un hospital terciario de Madrid, España.Resultados:Se analizaron 441 pacientes: 423 sin COVID-19 y 18 con COVID-19. Las características preoperatorias y operatorias fueron similares para ambos grupos, salvo por el grado ASA (American Society of Anesthesiologists).La incidencia de COVID-19 en los pacientes intervenidos fue del 4,1 %. La mortalidad postoperatoria fue elevada, del 22,2 % en pacientes con COVID‑19, frente a un 2,8 % en pacientes no COVID‑19 (p: 0,003). Los factores de riesgo para la infección por COVID-19 en los pacientes intervenidos fueron una estancia hospitalaria prolongada (OR: 1,035 [95 % CI: 1,007 ‑ 1,065]) y la reintervención quirúrgica (OR: 5,025 [95 % CI: 1,650 – 15,311]).Conclusión:Las intervenciones durante la pandemia de COVID-19 causaron una baja tasa de infección con elevada mortalidad postoperatoria. La intervención quirúrgica debe valorarse frente al riesgo adicional para el paciente en contextos de alta transmisión.