Case Study – 65 Year Old Man

A 65-year-old man with no significant past medical or surgical history who previously underwent an attempted but aborted resection of a left retroperitoneal DDLPS.

  • Left colectomy was performed at that time
  • Neoadjuvant systemic therapy had been discussed but upfront surgery was elected
  • Postoperatively, Adriamycin (doxorubicin)/ifosfamide were initiated locally
  • Patient presented to the institution for a second opinion. The patient reported that he also felt a “lump in the left flank/back”
  • Physical exam: well-appearing thin man
  • Abdominal exam: a palpable firm mass in the left abdomen

CT imaging

  • A large left retroperitoneal tumor with indistinct borders and concern for extension to the abdominal wall
  • Enhancing areas of the abdominal wall concerning for metastasis vs biopsy tract seeding
  • No evidence of pulmonary lesions


  • Biopsy of abdominal wall lesion confirmed additional sites of DDLPS

Prognosis: 7-year OS 23% and 7-year DFS 2%


  • Tumor resection with en bloc resection of portion of left diaphragm, left 11th/12th ribs, abdominal wall and plastics reconstruction.


Every 3 months and no evidence of disease for 1 year.  Afterwards, developed site of biopsy-confirmed metastasis.

At this stage, what factors are taken into consideration when deciding the treatment plan?

What is the most commonly chosen treatment modality at this stage?