Background. The postoperative course of patients undergoing resection of desmoid tumors is difficult to predict, and an understanding of the factors associated with recurrence may help guide management of these patients.
Methods. Data were collected retrospectively on patients undergoing resection of intra-abdominal, retroperitoneal, and abdominal wall tumors at a single institution between March 1985 and June 2000.
Results. Twenty-seven patients (18 female; 8 with familial polyposis syndromes; mean age 37.7 years, SEM 0.4) underwent 33 complete or partial resections of desmoid tumors, including 19 masses in the abdominal wall, 11 in the mesentery, 9 involving the retroperitoneum, and 1 involving bowel alone. Nine operations involved partial bowel resections, and three patients subsequently required long-term total parenteral nutrition. Nine patients experienced some form of recurrent disease, locally (8) and/or remotely (4). Four of the 16 operations for intra-abdominal and retroperitoneal tumors were followed by recurrence or progression at a mean time of 21.6 months (SEM 12.8). In this subgroup, local recurrence was associated with a prior history of remote desmoid disease (p=0.009), and all patients experiencing local recurrence were women compared to 50% of those without recurrence (p=0.07). As expected, freedom from recurrence (mean follow-up 28.3 months, SEM 7.8) was associated with an aggressive resection (p=0.04), defined as resection achieving negative margins even at the expense of major structures. Operations for abdominal wall desmoids (19) were more likely to be associated with recurrence when the patient carried a diagnosis of familial polyposis (p=0.05). No significant associations were found between recurrence and age, location of involvement, size of the mass, exogenous estrogen exposure, or medical adjunctive therapies. Average clinical follow-up was 52.0 months (SEM 1.4), and no patient died. Differences in follow-up between groups were not significant.
Conclusions. These data support attempts at complete resection of desmoid tumors, even at the expense of significant organ resection and irrespective of tumor size. Patients with remote desmoids appear more likely to suffer recurrence. Further investigations into the role of aggressive resections and the use of adjunctive therapies are warranted.