Retroperitoneal sarcoma is a rare and serious type of cancer that requires complex surgery. Doctors in Spain and Portugal were asked about how they prepare patients for this surgery and care for them afterward. The survey found that hospitals use very different approaches, and only a few have special protocols designed specifically for this type of surgery. Most doctors support creating standardized guidelines to make sure all patients receive the best possible care, no matter which hospital they go to.

The Quick Take

  • What they studied: How hospitals in Spain and Portugal prepare patients for and care for them after surgery to remove a rare type of abdominal cancer called retroperitoneal sarcoma
  • Who participated: 37 surgeons from hospitals across Spain and Portugal who regularly perform this type of surgery answered a detailed online survey about their practices
  • Key finding: Only 27% of hospitals have a special care plan designed for this specific surgery, even though 89% use special care plans for other types of surgery. This shows a major gap in how hospitals treat these rare cancer patients
  • What it means for you: If you or a loved one needs surgery for this rare cancer, the quality of care might depend on which hospital you go to. Doctors agree that creating standard guidelines would help ensure everyone gets the same high-quality care

The Research Details

Researchers sent an online survey to surgeons in Spain and Portugal who specialize in removing retroperitoneal sarcomas. The survey asked detailed questions about five main areas: basic information about the doctors, how they prepare patients before surgery, what they do during surgery, how they care for patients after surgery, and whether they support creating standard guidelines. Out of 266 surgeons who started the survey, 37 completed it fully and their answers were analyzed.

The survey covered important topics like whether patients quit smoking before surgery, if they received nutrition support, whether doctors used special techniques to manage fluids during surgery, and how quickly patients could eat and move around after surgery. The researchers looked for patterns in how different hospitals approached the same procedures.

This research is important because retroperitoneal sarcoma is very rare, which means most hospitals don’t perform many of these surgeries. When hospitals don’t have standard procedures for rare surgeries, patients may not receive the best possible care. By surveying what doctors are actually doing, researchers can identify which practices work best and create guidelines that all hospitals should follow. This helps ensure that whether you’re treated in Madrid or Lisbon, you’ll receive consistent, high-quality care.

This survey has some important limitations to understand. Only 37 out of 266 surgeons completed the full survey, which is a relatively small response rate. The survey only included hospitals in Spain and Portugal, so the results may not apply to other countries. Because this is a survey of what doctors say they do (rather than watching them actually perform surgery), there may be differences between what they reported and what actually happens. However, the survey does provide valuable insight into current practices across two countries and identifies areas where improvement is needed.

What the Results Show

The survey revealed significant differences in how hospitals prepare patients for retroperitoneal sarcoma surgery. While 89% of hospitals use special recovery protocols for other types of surgery, only 27% have created a specific protocol for this rare cancer surgery. This suggests that hospitals are not adapting their best practices to this particular procedure.

Before surgery, preparation varied widely. Only 21.6% of hospitals helped patients quit smoking before their operation, even though smoking increases surgical risks. About 73% provided nutritional support to strengthen patients before surgery, but only 37.8% offered supervised exercise programs. During surgery, about half of the hospitals (51.4%) used advanced techniques to carefully manage fluids given to patients, while nearly all hospitals (97.3%) followed guidelines about when to give blood transfusions.

After surgery, there was considerable variation in how quickly patients could eat regular food, when they could start walking around, and whether tubes were placed in their noses. These differences suggest that hospitals are making individual decisions rather than following evidence-based guidelines. Importantly, all 37 surgeons surveyed agreed that creating standardized guidelines specifically for retroperitoneal sarcoma surgery would be beneficial.

The survey found that most hospitals are already using enhanced recovery protocols for other types of surgery, which shows they understand the value of standardized approaches. However, they haven’t extended these proven methods to retroperitoneal sarcoma surgery. The high agreement (100%) among surgeons that standardized guidelines are needed suggests there is strong support for creating these protocols. The variation in postoperative care—including differences in when patients resume eating, mobilization timing, and nasogastric tube use—indicates that hospitals are making decisions based on tradition or individual surgeon preference rather than evidence-based research.

Enhanced Recovery After Surgery (ERAS) protocols have been successfully used in many other types of surgery, including colorectal, orthopedic, and cardiac procedures, where they’ve improved patient outcomes and reduced complications. This research shows that while these proven methods are being used for common surgeries, they haven’t been adapted for rare cancers like retroperitoneal sarcoma. The findings suggest that rare cancers may be overlooked when developing standardized care guidelines, even though patients with these conditions may benefit just as much from organized, evidence-based approaches.

This study has several important limitations. First, only 37 surgeons completed the survey out of 266 who started it, which means the results may not represent all surgeons in Spain and Portugal. Second, the survey only included two countries, so these findings may not apply to hospitals in other parts of Europe or the world. Third, the survey asked doctors what they do, but didn’t observe actual surgeries or patient outcomes, so there may be differences between what doctors reported and what actually happens in practice. Finally, because retroperitoneal sarcoma is rare, even these 37 surgeons may not perform many of these surgeries each year, which could affect how standardized their practices are.

The Bottom Line

Based on this research, surgeons should work together to create standardized guidelines for preparing patients before retroperitoneal sarcoma surgery and caring for them afterward. These guidelines should include: helping patients quit smoking before surgery, providing nutritional support, offering supervised exercise programs, using advanced fluid management techniques during surgery, and establishing clear protocols for when patients can eat, move around, and have tubes removed after surgery. These recommendations have moderate confidence because they’re based on what works for other surgeries, but more research specific to retroperitoneal sarcoma is needed.

This research matters most for people diagnosed with retroperitoneal sarcoma and their families, as well as surgeons and hospitals that treat this rare cancer. If you’re facing this surgery, you should ask your hospital whether they have a specific protocol for this procedure and whether they offer prehabilitation (preparation before surgery) services. Hospitals should use this research to develop standardized guidelines. This research is less relevant for people with other types of cancer or those undergoing different surgeries, though the general principles of organized surgical care apply broadly.

If hospitals implement standardized guidelines based on this research, patients should expect to see improvements in their recovery within weeks to months after surgery. Some benefits, like reduced complications and faster return to normal activities, may be noticeable within the first few weeks. Other benefits, like improved long-term survival and quality of life, would take longer to measure and would require tracking patients over several years.

Want to Apply This Research?

  • If you’re preparing for retroperitoneal sarcoma surgery, track your prehabilitation activities: record daily steps walked, nutrition intake (especially protein), smoking cessation progress, and any supervised physical therapy sessions. Use the app to set goals like ‘walk 30 minutes daily’ or ’eat 100g protein’ and monitor completion rates leading up to surgery.
  • Use the app to create a pre-surgery preparation plan that includes: setting a smoking quit date and tracking days smoke-free, logging daily nutrition goals, scheduling and completing physical therapy sessions, and recording any questions to ask your surgical team about their specific protocol for your care.
  • After surgery, use the app to track your recovery milestones: when you first eat solid food, daily walking distance, pain levels, return to normal activities, and any complications. Share this data with your healthcare team to ensure you’re following the recommended recovery protocol and to identify any concerns early.

This research describes current surgical practices for a rare and serious cancer. It does not provide medical advice for individual patients. If you have been diagnosed with retroperitoneal sarcoma or are considering surgery, consult with your surgical team about the specific approach they recommend for your situation. Treatment decisions should be made in partnership with your doctors based on your individual health status, the extent of your cancer, and other personal factors. This article is for educational purposes only and should not replace professional medical advice.