title: Large desmoid-type fibromatosis of the shoulder girdle: operative approach selection and clinic outcome.
abstract: OBJECTIVE
  Surgical resection of large desmoid-type fibromatosis (DTF) of the shoulder girdle is challenging. This article discusses the operative approach and evaluates the clinic outcome.
  
  
  METHODS
  Twenty-one cases between June 2003 and June 2012 were retrospectively reviewed. Eleven patients newly diagnosed and ten had previous operations. Mean tumour size was 10.5 cm (range, 7.0-19.0 cm). We divided the shoulder girdle into four regions; the adopted surgical resection was en bloc in 18 cases and piecemeal resection in three. In nine cases we took an anterior approach, ten a posterior approach and two a combined anteroposterior (AP) approach. Brachytherapy with permanent I(125) implantation was applied in all cases.
  
  
  RESULTS
  All 21 patients were followed up for a mean of 49.8 (range, 18-136) months. Recurrence was seen in two patients, with the overall recurrence rate of 9.5 %. The Musculoskeletal Tumour Score (MSTS) was between 56.7 and 96.7 %, with the average at 78.9 % and excellent-good rate 95.2 %. Complications were found in three of the 21 patients (14.3 %).
  
  
  CONCLUSIONS
  Surgical resection with the precondition of preserving vital structure for large DTF of the shoulder girdle is necessary. According to our new partition, it was suitable to take an anterior approach when regions I or I + II were involved, posterior approach for regions II, III or II + III; combined AP approach when involving region I + II + III; and anterior or posterior approach for region IV, depending upon tumour location.
authors: Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, 610041, China.
authors: Fan
authors: F
authors: Tang
authors: Li
authors: L
authors: Min
authors: Rui
authors: R
authors: Yin
authors: Wenli
authors: W
authors: Zhang
authors: Yong
authors: Y
authors: Zhou
authors: Yi
authors: Y
authors: Luo
authors: Rui
authors: R
authors: Shi
authors: Hong
authors: H
authors: Duan
authors: Chongqi
authors: C
authors: Tu
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000601:surgery*; D005260:Female; D018222:Desmoid Tumors / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D019637:Orthopedic Procedures / Q000379:methods*; D012189:Retrospective Studies; D012782:Shoulder; D016896:Treatment Outcome; D055815:Young Adult