Desmoid tumor surgery: Difference between revisions
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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> | 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> | ||
==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 management for aggressive fibromatosis depends on tumor location and 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 with a grossly negative microscopic margin followed by reconstruction of the defect is the standard surgical goal | *The goals of surgery are twofold: | ||
*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 | **To remove the tumor | ||
**To restore function at the site of the tumor | |||
*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) | |||
*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 | |||
*Skin grafting or flap reconstruction may be required after resection due to the size and infiltrative nature of extraabdominal desmoids | *Skin grafting or flap reconstruction may be required after resection due to the size and infiltrative nature of extraabdominal desmoids | ||
*Abdominal wall resection may be required to close the defect and minimize the risk of hernias after resection of abdominal wall desmoids | *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 | *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 | *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 | *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 | *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 | *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 | *It is estimated that 25 to 40% of patients who undergo surgery can have a local recurrence | ||
==Reference== | ==Reference== | ||
Revision as of 04:53, 5 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]Faizan Sheraz, M.D. [3]
Overview
Surgical resection is not recommended among patients with advanced or metastatic malignancy.[1]
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:
- To remove the tumor
- To restore function at the site of the tumor
- 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
- Skin grafting or flap reconstruction may be required after resection due to the size and infiltrative nature of extraabdominal desmoids
- 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