Soft tissue sarcomas (STS) are a heterogeneous group of malignant tumours arising from mesenchymal tissues — fat (liposarcoma), smooth muscle (leiomyosarcoma), nerve sheath (MPNST), blood vessels (angiosarcoma), and fibrous tissue (fibrosarcoma, DFSP). They can arise anywhere in the body, but abdominal and retroperitoneal sarcomas present unique surgical challenges because of their proximity to major vascular structures and vital organs.

Retroperitoneal sarcomas (RPS) — most commonly retroperitoneal liposarcoma and leiomyosarcoma — are among the most technically demanding tumours to resect. The principles of sarcoma surgery are fundamentally different from carcinoma surgery: wide en-bloc resection encompassing the tumour within a rim of uninvolved tissue is the goal. For retroperitoneal liposarcoma, this typically means resecting the ipsilateral kidney, adrenal gland, and any involved bowel segment — even if not directly invaded — to achieve adequate oncological margins.

All patients with suspected sarcoma must be evaluated at a specialist sarcoma centre before any biopsy or surgery. The manner in which a sarcoma is biopsied and the initial surgical approach can determine whether cure is achievable. An unplanned “whoops” excision — removing a sarcoma without adequate margins in an unplanned operation — contaminates the field and dramatically worsens outcomes.