Desmoid tumor surgery
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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
- 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 vists
- Imaging of the tumor site with ultrasound or MRI scans may be recommended to closely monitor patient’s health on follow up visits