Abstract
The mainstay of treatment for desmoid has been shifted to active surveillance (AS). However, surgery is still being performed on abdominal wall desmoid with a wide surgical margin. The purposes of this study are to clarify the treatment results of less-invasive, fascia preserving surgery for patients with abdominal wall desmoid, and to propose a new treatment modality. Since 2009, 34 patients with abdominal desmoid have been treated in our institution. Among them, as a final treatment modality, 15 (44%) were successful with AS, 15 were subjected to less-invasive surgery, and 4 methotrexate and vinblastine treatment. The clinical results of less-invasive surgery were clarified. In the surgical group, although the surgical margin was all microscopic positive (R1), only one patient (6.7%), who has the S45F mutation type of CTNNB1, showed recurrence, at a mean follow-up of 45 months. There were no patients with familial adenomatous polyposis (FAP)-related desmoid in this cohort. Only two patients (13%) required fascia lata patch reconstruction after removal of the tumor. In patients with non FAP-related abdominal wall desmoid, less-invasive, fascia preserving surgery is recommended as a favorable option as active treatment. Based on the results of this study, multi-institutional further research is warranted with an increased number of patients.
Highlights
The mainstay of treatment for desmoid has been shifted to active surveillance (AS)
Since 2003, the treatment modality for abdominal wall desmoid at our institution recommends non-surgical treatment initially with administration of the selective COX-2 inhibitor m eloxicam[19,20], but since July 2017, AS without non-steroidal anti-inflammatory drugs (NSAIDs) including COX-2 inhibitor has been employed as the initial treatment policy, which is in accordance with the present consensus g uideline[9]
When the tumor size increased significantly and/or the activities of daily living (ADL)/quality of life (QOL) disorder became worse, they were referred to our hospital
Summary
The mainstay of treatment for desmoid has been shifted to active surveillance (AS). surgery is still being performed on abdominal wall desmoid with a wide surgical margin. The purposes of this study are to clarify the treatment results of less-invasive, fascia preserving surgery for patients with abdominal wall desmoid, and to propose a new treatment modality. In patients with non FAP-related abdominal wall desmoid, less-invasive, fascia preserving surgery is recommended as a favorable option as active treatment. The recurrence rate has been found to be higher in children and adolescents[8] For these reasons, the treatment modality for desmoid has changed in recent years, and the policy is to first follow up with active surveillance (AS) without performing surgery[9,10]. If there is no difference in the results between the method of removing only the macroscopic tumor and microscopic negative margin surgery for abdominal wall desmoid, non-invasive surgery has advantages for patients
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