Surgical Management of Desmoid Tumors: Impact of Reconstruction on Recurrence

Summary

We present the multidisciplinary treatment of 20 patients with resectable desmoid tumors, reconstruction method, and experience in managing recurrences. After institutional board review approval, the clinical course of 20 patients diagnosed with desmoid tumors and treated by the University of Texas Southwestern multidisciplinary team were retrospectively reviewed over an 8-year period to analyze patient characteristics and surgical outcomes. Patient, tumor, treatment, and outcome data were compared between patients who underwent surgical resection with formal reconstruction and patients who underwent resection with primary closure. Twenty patients were included in our study. Of those 11 (55%) underwent reconstruction, whereas 9 (45%) underwent primary closure. Primary closure patients were more likely to have positive marginal status post resection (55.6% versus 9.09%; P = 0.050) and higher rate of recurrence (66.6% versus 0%; P = 0.0012) than patients who underwent reconstruction. No recurrences occurred in the reconstructive group; the reconstructive group had significantly higher rates of desmoids located in the abdominal wall than those who underwent primary closure (72.7% versus 11.1%; P = 0.009). Reconstructive surgery was not found to be a risk factor for recurrence. In fact, primary closure was associated with higher reoccurrence and positive margins. This might suggest that during resection, surgeons are focusing more on primary wound closure versus insuring negative marginal status. Collaboration between reconstructive and oncologic surgeons is necessary in the management and potential treatment of desmoid tumors.