While several decades ago soft tissue sarcoma was often managed as one disease, we now recognize that sarcoma is an umbrella term encompassing almost 100 different pathologies, each characterized by unique genetic aberrations. In many ways, the field of sarcoma biology is on the cutting edge of personalized medicine; we routinely use histologic and molecular information to individualize management algorithms. In this issue of Annals of Surgical Oncology, Gronchi et al. present data collected over a 10-year period, and describing outcomes after resection of primary retroperitoneal sarcomas at the Instituto Nazionale Tumori (INT) in Milan and the Institute Gustave Roussy (IGR) in Paris. The study delineates rates of local and distal recurrence as they associate with histology. The results bring up numerous questions regarding our selection of patients for surgery and adjuvant therapy, as well as the manner in which we design and interpret clinical trials seeking to optimize management o ...