Desmoid tumor surgery: Difference between revisions
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{{Desmoid tumor}} | {{Desmoid tumor}} | ||
{{CMG}} {{AE}}{{S.M. | {{CMG}} {{AE}}{{S.M.}} | ||
==Overview== | ==Overview== | ||
The goals of [[surgery]] include [[tumor]] removal and functional restoration at the [[tumor]] site. [[Standard]] surgical goal is [[wide local excision]] with a grossly negative [[microscopic]] margin followed by reconstruction of [[defect]] with [[skin graft]], rotational [[muscle]] flap or free [[muscle]] flap. [[Abdominal wall]] [[resection]] may be required to close the [[defect]] and minimize the risk of [[hernias]]. Incomplete [[tumor]]<nowiki/>removal or involved [[excision]] margins may lead to local recurrence in 25% to 40% of [[patients]]. Hence, because of high recurrence risk post-[[surgery]], [[imaging]] of the [[tumor]] site with [[ultrasound]] or [[MRI scans]] may be recommended to closely monitor [[Patient|patient’s]] [[health]] on follow up visits after [[surgery]]. | |||
==Surgery== | ==Surgery== | ||
*Surgical resection is not recommended among patients with advanced or metastatic [[malignancy]] | *[[Surgical resection]] is not recommended among [[patients]] with advanced or [[metastatic]] [[malignancy]]<ref name="EconomouPitta2011">{{cite journal|last1=Economou|first1=Athanasios|last2=Pitta|first2=Xanthi|last3=Andreadis|first3=Efstathios|last4=Papapavlou|first4=Leonidas|last5=Chrissidis|first5=Thomas|title=Desmoid tumor of the abdominal wall: a case report|journal=Journal of Medical Case Reports|volume=5|issue=1|year=2011|pages=326|issn=1752-1947|doi=10.1186/1752-1947-5-326}}</ref> | ||
*Desmoid tumor does not have any propensity for metastasis although it may aggressively invade structures | *[[Desmoid tumor]] does not have any propensity for [[metastasis]] although it may aggressively invade structures | ||
*The optimal management for aggressive fibromatosis depends on tumor location and extent | *The [[Optimal classification|optimal]] management for [[aggressive fibromatosis]] depends on [[tumor]] [[Location parameter|location]] and [[Extent of reaction|extent]] | ||
*Surgical resection may be offered although the likelihood of local recurrence after surgery is high, particularly if margins are positive | ===Goals of surgery=== | ||
*Wide local excision followed by reconstruction of the defect is the | *The goals of [[surgery]] are twofold: | ||
*Full-thickness resection of the tumor-containing abdominal wall with a grossly negative margin has to be performed when the lesion closely approximates or involves the peritoneum | **To remove the [[tumor]] | ||
*Intraperitoneal organs or adjacent bony structures involved by tumor must be resected as well | **To restore [[Function (biology)|function]] at the site of the [[tumor]] | ||
*Incomplete tumor removal or involved excision margins may lead to local recurrence | *[[Surgical resection]] may be offered although the [[likelihood]] of local [[Recurrence plot|recurrence]] after [[surgery]] is high, particularly if margins are positive | ||
*It is estimated that 25 to 40% of patients who undergo surgery can have a local recurrence | *[[Wide local excision]] with a grossly negative [[microscopic]] margin followed by [[Reconstruction algorithm|reconstruction]] of the [[defect]] is the [[standard]] surgical goal | ||
**[[Reconstruction algorithm|Reconstruction]] may include: | |||
***[[Skin graft]] (from [[Patient|patient's]] own [[thigh]] or [[buttocks]] to cover and protect the [[area]] where the [[tumor]] was removed) | |||
***Rotational [[muscle]] flap (taken from [[Patient|patient's]] own [[muscle]] near the [[surgery]] site, and rotated to fill the [[area]] where the [[tumor]] was removed) | |||
***Free [[muscle]] flap ([[muscle]] is taken from somewhere else in the [[Patient|patient's]] own [[Human body|body]], relocated, and then reconnected with the [[blood vessels]] in the [[area]] where the [[tumor]] was removed) | |||
*Full-thickness [[resection]] of the [[tumor]]-containing [[abdominal wall]] with a grossly negative microscopic margin has to be performed when the [[lesion]] closely approximates or involves the [[peritoneum]] | |||
*[[Abdominal wall]] [[resection]] may be required to close the [[defect]] and minimize the risk of [[hernias]] after [[resection]] of [[abdominal wall]] [[Desmoid tumor|desmoids]] | |||
*As intraabdominal [[Desmoid tumor|desmoids]] usually involve the [[mesentery]], so the [[resection]] generally requires concomitant [[bowel resection]] | |||
*[[Surgeon]] must take care not to compromise the [[superior mesenteric artery]] or [[vein]] during [[resection]] | |||
*Given the propensity of [[Desmoid tumor|desmoids]] to recur, [[Reconstruction algorithm|reconstruction]] should allow for the possibility of future [[Resection|resections]] and [[Reconstruction algorithm|reconstructions]] | |||
*Intraperitoneal [[organs]] or adjacent bony structures involved by [[tumor]] must be resected as well | |||
*Incomplete [[tumor]] removal or involved [[excision]] margins may lead to [[local]] [[Recurrence plot|recurrence]] | |||
*It is estimated that 25 to 40% of [[patients]] who undergo [[surgery]] can have a [[local]] [[Recurrence plot|recurrence]] | |||
*Because of high [[Recurrence plot|recurrence]] rate even after being successfully treated, it is necessary for the [[patient]] to keep seeing a [[physician]] regularly for follow up visits | |||
*[[Imaging]] of the [[tumor]] site with [[ultrasound]] or [[MRI scans]] may be recommended to closely [[Monitor (NHS)|monitor]] [[Patient|patient’s]] [[health]] on follow up visits | |||
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[[File:Desmoid surgery gif.gif|thumb|600px|none|Successful outcome after laparoscopic surgery for sporadic colonic desmoid tumor with β-catenin mutation: a case report. Magnetic resonance imaging findings showed the desmoid tumor (arrows) with lower signal intensity on T1-weighted image (a) and high signal intensity on T2-weighted image (b and c). Note that the desmoid tumor was next to contrast-filled transverse colon. (a and b) Axial plane. (c) Coronal plane.[https://openi.nlm.nih.gov/detailedresult?img=PMC3637375_1752-1947-7-100-1&query=desmoid%20tumor&it=xg&req=4&npos=5 Source: Gunji S. et al, Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin- Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan]]] | |||
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==Reference== | ==Reference== | ||
Latest revision as of 03:39, 25 March 2019
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Desmoid tumor Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sara Mohsin, M.D.[2]
Overview
The goals of surgery include tumor removal and functional restoration at the tumor site. Standard surgical goal is wide local excision with a grossly negative microscopic margin followed by reconstruction of defect with skin graft, rotational muscle flap or free muscle flap. Abdominal wall resection may be required to close the defect and minimize the risk of hernias. Incomplete tumorremoval or involved excision margins may lead to local recurrence in 25% to 40% of patients. Hence, because of high recurrence risk post-surgery, imaging of the tumor site with ultrasound or MRI scans may be recommended to closely monitor patient’s health on follow up visits after surgery.
Surgery
- Surgical resection is not recommended among patients with advanced or metastatic malignancy[1]
- Desmoid tumor does not have any propensity for metastasis although it may aggressively invade structures
- The optimal management for aggressive fibromatosis depends on tumor location and extent
Goals of surgery
- The goals of surgery are twofold:
- Surgical resection may be offered although the likelihood of local recurrence after surgery is high, particularly if margins are positive
- Wide local excision with a grossly negative microscopic margin followed by reconstruction of the defect is the standard surgical goal
- Reconstruction may include:
- Skin graft (from patient's own thigh or buttocks to cover and protect the area where the tumor was removed)
- Rotational muscle flap (taken from patient's own muscle near the surgery site, and rotated to fill the area where the tumor was removed)
- Free muscle flap (muscle is taken from somewhere else in the patient's own body, relocated, and then reconnected with the blood vessels in the area where the tumor was removed)
- Reconstruction may include:
- Full-thickness resection of the tumor-containing abdominal wall with a grossly negative microscopic margin has to be performed when the lesion closely approximates or involves the peritoneum
- Abdominal wall resection may be required to close the defect and minimize the risk of hernias after resection of abdominal wall desmoids
- As intraabdominal desmoids usually involve the mesentery, so the resection generally requires concomitant bowel resection
- Surgeon must take care not to compromise the superior mesenteric artery or vein during resection
- Given the propensity of desmoids to recur, reconstruction should allow for the possibility of future resections and reconstructions
- Intraperitoneal organs or adjacent bony structures involved by tumor must be resected as well
- Incomplete tumor removal or involved excision margins may lead to local recurrence
- It is estimated that 25 to 40% of patients who undergo surgery can have a local recurrence
- Because of high recurrence rate even after being successfully treated, it is necessary for the patient to keep seeing a physician regularly for follow up visits
- Imaging of the tumor site with ultrasound or MRI scans may be recommended to closely monitor patient’s health on follow up visits
 |
Reference
- ↑ Economou, Athanasios; Pitta, Xanthi; Andreadis, Efstathios; Papapavlou, Leonidas; Chrissidis, Thomas (2011). "Desmoid tumor of the abdominal wall: a case report". Journal of Medical Case Reports. 5 (1): 326. doi:10.1186/1752-1947-5-326. ISSN 1752-1947.