Spontaneous regression of primary abdominal wall desmoid tumors: more common than previously thought.
OBJECTIVE
The relevance of the initial observational approach for desmoid tumors (DTs) remains unclear. We investigated a new conservative management treatment for primary abdominal wall DTs.


METHODS
Data were collected from 147 patients between 1993 and 2012. The initial therapeutic approaches were categorized as front-line surgery [surgery group (SG), n = 41, 28 %] and initial observation or medical treatment [nonsurgery group (NSG), n = 106, 72 %]. The cumulative incidence of the last strategy modification was estimated using competing risk methods with variable censoring times.


RESULTS
Of the 147 patients, 143 were female (97 %). In the SG, 27 patients (66 %) required full-thickness abdominal wall mesh repair. In the NSG, 102 patients (96 %) underwent initial observation and four received medical treatment. In the NSG, the 1- and 3-year incidences of changing to medical treatment (no further changes during the follow-up) were 19 % [95 % confidence interval (CI) 11-28] and 25 % (95 % CI 17-35), respectively, and the 1- and 3-year incidences of a final switch to surgery were 14 % (95 % CI 8-22) and 16 % (95 % CI 9-24), respectively. An initial tumor size of >7 cm was associated with a higher strategy modification risk (p = 0.004). Of the 102 patients initially observed, 29 experienced spontaneous regression over a median follow-up period of 32 months. All second-intent resections were macroscopically completed, with R0 resections achieved in 82 % of patients.


CONCLUSIONS
This study supports an initial nonsurgical approach to abdominal wall DTs ≤7 cm, followed by surgery based on tumor growth in select cases.
Department of Surgery, Gustave Roussy Institute, Villejuif, France, sylvie.bonvalot@gustaveroussy.fr.
Sylvie
S
Bonvalot
Nils
N
Ternès
Marco
M
Fiore
Georgina
G
Bitsakou
Chiara
C
Colombo
Charles
C
Honoré
Andrea
A
Marrari
Axel
A
Le Cesne
Federica
F
Perrone
Ariane
A
Dunant
Alessandro
A
Gronchi
D000008:Abdominal Neoplasms / Q000473:pathology* / Q000601:surgery; D034861:Abdominal Wall / Q000473:pathology* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D018221:Fibromatosis, Abdominal / Q000473:pathology* / Q000601:surgery; D018222:Desmoid Tumors / Q000473:pathology* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D011379:Prognosis; D055815:Young Adult