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.
- 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
- 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