Intra-abdominal metastases from soft tissue sarcoma

Objective: To define the clinical features and prognosis of patients with abdominal metastasis from primary soft tissue sarcoma (STS) at other sites. Methods: All patients with abdominal metastasis from STS were identified from the Royal Marsden Hospital Sarcoma Unit prospective database from January 1990 to July 2001. Results: Nineteen patients developed abdominal metastasis out of a cohort of 2127 patients (0.9%) evaluated during the study interval. The median age was 49 (19-71) years. The median time to abdominal metastasis from diagnosis of the primary was 27 (8-91) months. The presenting complaints were incomplete intestinal obstruction (n=5), abdominal pain (n=4), mass (n=2), gastrointestinal bleed (n=2), urinary obstruction (n=2), anorexia (n=1), and abdominal distension (n=1). Emergency laparotomy was done for perforative peritonitis (n=2). intussusception (n=2), and bleed in spleen (n=1). Two patients were asymptomatic. The common histologies were myxoid liposarcoma (n=6) and leiomyosarcoma (n=4). The median follow-up of survivors post metastasis was 12 months. Abdominal metastatectomy was performed in 16 patients, 3 of these patients had abdominal recurrences. The 1- and 2-year overall disease specific survival for the 19 patients was 66% (SE=11%) and 43% (SE=13%) with a median survival of 13 months (95% CI=11.8-14.7). Metastasectomy was associated with slight improved median post-metastasis survival (33 months vs. 8 months for unresected patients). Conclusions: Although abdominal metastasis is rare, vigilance is warranted. Symptomatic patients should be examined and investigated thoroughly for metastases. Surgery is the treatment of choice for patients with an acute presentation; however, survival is dismal.