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[Desmoid tumors: Are there still any surgical indications?]

Authors
  • Bonvalot, Sylvie1
  • Tzanis, Dimitri2
  • Bouhadiba, Toufik2
  • 1 Institut Curie, service de chirurgie sarcome et tumeurs complexes, Paris, France. Electronic address: [email protected] , (France)
  • 2 Institut Curie, service de chirurgie sarcome et tumeurs complexes, Paris, France. , (France)
Type
Published Article
Journal
Bulletin du cancer
Publication Date
Dec 04, 2019
Identifiers
DOI: 10.1016/j.bulcan.2019.08.022
PMID: 31812283
Source
Medline
Keywords
Language
French
License
Unknown

Abstract

After an adapted imaging, the diagnosis of a desmoid tumor (DT) is provided by a percutaneous microbiopsy, with a molecular analysis for beta-catenin or APC gene mutation. The therapeutic strategy must be decided in a specialized multidisciplinary tumor board (MTB). Surgery is no longer the first-line treatment for a DT. Except within a surgical complication, active surveillance is offered to the majority of patients, since more than half stabilize or regress after an initial progression, whether the location is peripheral or intra-abdominal. If the localization and/or volume are likely to be functional or life-threatening, medical induction therapy is discussed in MTB, before a local treatment whose potential sequelae would be definitive. Incomplete unplanned resection, recurrence, pregnancy or desmoids occurring in a polyposis context are no longer routine surgical indications. In an emergency setting (occlusion, peritonitis), it is discussed to treat only the mechanical complication and leave the DT in place, if its resection would lead to too much digestive resection, especially in patients who have already undergone colectomy for polyposis. The best indications for surgery are patients who have parietal locations with significant and documented progression, because surgery can be easily completed at the cost of an acceptable morbidity. In localizations where surgery would cause sequelae, medical treatment or other regional loco treatments are discussed in MTB. Copyright © 2019 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

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