[en] [en] BACKGROUND: The aim of the study is to evaluate functional and oncological outcomes of patients undergoing abdominal wall soft tissue tumors (AWSTT) surgery.
METHODS: All consecutive patients that underwent surgery for malignant and intermediate AWSTT from 1999 to 2019 were retrospectively analyzed.
RESULTS: Ninety-two patients were identified, 20 (22%) operated on for a desmoid tumor and 72 (78%) for a soft tissue sarcoma (STS). Fifty-two patients (57%) had in toto resection of the abdominal wall (from the skin to the peritoneum) and 9 (10%) required simultaneous visceral resection. The closure was direct in 28 patients (30%) and requiring a mesh, a flap or a combination of the two in respectively 42, 16, and 6 patients (47%, 17%, 6%). The postoperative complications rate was 26%. Thirteen patients (14%) developed an incisional hernia after a median delay of 27 months. After a median follow-up of 40 months, out of the 72 patients operated on for STS, 7 (10%) developed local recurrence and 11 (15%) distant recurrence. The median recurrence-free and overall survivals were 61 and 116, months respectively.
CONCLUSIONS: Management of AWSTT requires extensive surgery but allows good local control with an acceptable rate of incisional hernia.
Disciplines :
Surgery
Author, co-author :
Neuberg, Maud ; Centre Hospitalier Universitaire de Liège - CHU > > Service de chirurgie abdo, sénologique, endocrine et de transplantation ; Department of Surgical Oncology, Gustave Roussy, Villejuif, France
Mir, Olivier; Department of Ambulatory Cancer Care, Gustave Roussy, Villejuif, France ; Department of Medical Oncology, Gustave Roussy, Villejuif, France
Levy, Antonin; Department of Radiation Oncology, Gustave Roussy, Villejuif, France
Sourrouille, Isabelle; Department of Surgical Oncology, Gustave Roussy, Villejuif, France
Dumont, Sarah; Department of Medical Oncology, Gustave Roussy, Villejuif, France
Haddag-Miliani, Leila; Department of Radiology, Gustave Roussy, Villejuif, France
Ngo, Carine; Department of Pathology, Gustave Roussy, Villejuif, France
Mihoubi, Fadila; Department of Radiology, Gustave Roussy, Villejuif, France
Rimareix, Françoise; Department of Plastic Surgery, Gustave Roussy, Villejuif, France
Le Péchoux, Cécile; Department of Radiation Oncology, Gustave Roussy, Villejuif, France
Adam, Julien; Department of Pathology, Gustave Roussy, Villejuif, France
Honart, Jean-François; Department of Plastic Surgery, Gustave Roussy, Villejuif, France
Ceribelli, Cecilia; Department of Surgical Oncology, Gustave Roussy, Villejuif, France
Le Cesne, Axel; Department of Medical Oncology, Gustave Roussy, Villejuif, France
Leymarie, Nicolas; Department of Plastic Surgery, Gustave Roussy, Villejuif, France
Faron, Matthieu; Department of Surgical Oncology, Gustave Roussy, Villejuif, France
Honoré, Charles; Department of Surgical Oncology, Gustave Roussy, Villejuif, France
Desmoid Tumor Working Group. The management of desmoid tumours: a joint global consensus-based guideline approach for adult and paediatric patients. Eur J Cancer. 2020;127:96-107.
Pencavel T, Strauss DC, Thomas JM, Hayes AJ. The surgical management of soft tissue tumours arising in the abdominal wall. Eur J Surg Oncol. 2010;36:489-495.
Kasper B, Baumgarten C, Bonvalot S, et al. Management of sporadic desmoid-type fibromatosis: a European consensus approach based on patients' and professionals' expertise—a sarcoma patients EuroNet and European Organisation for Research and Treatment of Cancer/Soft Tissue and Bone Sarcoma Group initiative. Eur J Cancer. 2015;51:127-136.
Stiller CA, Trama A, Serraino D, et al. Descriptive epidemiology of sarcomas in Europe: report from the RARECARE project. Eur J Cancer. 2013;49:684-695.
Stojadinovic A, Hoos A, Karpoff HM, et al. Soft tissue tumors of the abdominal wall: analysis of disease patterns and treatment. Arch Surg. 2001;136:70-79.
Rosenberg SA, Tepper J, Glatstein E, et al. The treatment of soft-tissue sarcomas of the extremities: prospective randomized evaluations of limb-sparing surgery plus radiation therapy compared with amputation and the role of adjuvant chemotherapy. Ann Surg. 1982;196:305-315.
Bonvalot S, Rivoire M, Castaing M, et al. Primary retroperitoneal sarcomas: a multivariate analysis of surgical factors associated with local control. J Clin Oncol. 2009;27:31-37.
Fletcher CDM, Bridge JA, Hogendoorn PC, et al. WHO Classification of Tumours of Soft Tissue and Bone. Lyon: IARC. 2013
Trojani M, Contesso G, Coindre JM, et al. Soft-tissue sarcomas of adults; study of pathological prognostic variables and definition of a histopathological grading system. Int J Cancer. 1984;33:37-42.
Clavien PA, Barkun J, DeOliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187-196.
Clark MA, Fisher C, Judson I, Thomas JM. Soft-tissue sarcomas in adults. N Engl J Med. 2005;353:701-711.
Casali PG, Abecassis N, Aro HT, et al. Soft tissue and visceral sarcomas: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018;29:268-269.
Derbel O, Heudel PE, Cropet C, et al. Survival impact of centralization and clinical guidelines for soft tissue sarcoma (a prospective and exhaustive population-based cohort). PLoS One. 2017;12:e0158406.
Hoekstra HJ, Haas RLM, Verhoef C, et al. Adherence to Guidelines for Adult (Non-GIST) Soft Tissue Sarcoma in the Netherlands: a Plea for Dedicated Sarcoma Centers. Ann Surg Oncol. 2017;24:3279-3288.
Blay JY, Stoeckle E, Italiano A, et al. Improved overall and progression free survival after surgery in expert sites for sarcoma patients: a nationwide study of FSG-GETO/NETSARC. Ann Oncol. 2017;28:v521-v538.
Bonvalot S, Ternès N, Fiore M, et al. Spontaneous regression of primary abdominal wall desmoid tumors: more common than previously thought. Ann Surg Oncol. 2013;20:4096-4102.
Lewis JJ, Boland PJ, Leung DH, Woodruff JM, Brennan MF. The enigma of desmoid tumors. Ann Surg. 1999;229:866-872.
Al-Jazrawe M, Au M, Alman B. Optimal therapy for desmoid tumors: current options and challenges for the future. Expert Rev Anticancer Ther. 2015;15:1443-1458.
Schmitz JJ, Schmit GD, Atwell TD, et al. Percutaneous cryoablation of extraabdominal desmoid tumors: a 10-year experience. AJR Am J Roentgenol. 2016;207:190-195.
Kainhofer V, Smolle MA, Szkandera J, et al. The width of resection margins influences local recurrence in soft tissue sarcoma patients. Eur J Surg Oncol. 2016;42:899-906.
Trovik CS, Bauer HC, Alvegård TA, et al. Surgical margins, local recurrence and metastasis in soft tissue sarcomas: 559 surgically-treated patients from the Scandinavian Sarcoma Group Register. Eur J Cancer. 2000;36:710-716.
Gundle KR, Kafchinski L, Gupta S, et al. Analysis of Margin Classification Systems for Assessing the Risk of Local Recurrence After Soft Tissue Sarcoma Resection. J Clin Oncol. 2018;36:704-709.
Farma JM, Ammori JB, Zager JS, et al. Dermatofibrosarcoma protuberans: how wide should we resect? Ann Surg Oncol. 2010;17:2112-2118.
Smith HG, Tzanis D, Messiou C, et al. The management of soft tissue tumours of the abdominal wall. Eur J Surg Oncol. 2017;43:1647-1655.
Kao AM, Arnold MR, Augenstein VA, Heniford BT. Prevention and Treatment Strategies for Mesh Infection in Abdominal Wall Reconstruction. Plast Reconstr Surg. 2018;142:149S-155SS.
O'sullivan B, Davis AM, Turcotte R, et al. Preoperative versus post- operative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet. 2002;359:2235-2241.
Keus RB, Nout RA, Blay JY, et al. Results of a phase II pilot study of moderate dose radiotherapy for inoperable desmoid-type fibromatosis - an EORTC STBSG and ROG study (EORTC 62991-22998). Ann Oncol. 2013;24:2672-2676.
