Conservative management of desmoid tumors is safe and effective.
Surgical resection of desmoid tumors has traditionally been the mainstay of therapy, but this is a potentially morbid approach with high rates of recurrence. Given increasing reports of active surveillance in this disease, we sought to evaluate our experience with conservative management hypothesizing this would be an effective strategy.



Using a prospectively maintained database of sarcoma patients from 2008 to 2015, we identified 47 patients with a diagnosis of desmoid tumor from all anatomic sites. Data points were abstracted on clinical and pathologic factors, disease stability or progression, and follow-up time. Main outcome measurements were tumor recurrence after surgical resection versus tumor progression with conservative management.



In our cohort, 20 patients were managed with surveillance, 24 patients with surgery, and three patients with other approaches. Clinical and tumor characteristics between treatment groups were not significantly different. With a median follow-up of 35.7 mo, there was one complete regression, five partial regressions, and 13 stable diseases among the surveillance group. Only one patient under observation progressed, crossing over to surgical resection. Among 24 patients managed with surgery, 13 patients developed local recurrence. Kaplan-Meier analysis revealed a statistically superior progression-free survival in the surveillance group (P = 0.001).



This retrospective analysis adds to the growing body of evidence that observation of desmoid tumors is safe and effective with high rates of stable disease. These data further support an initial conservative approach to desmoid tumors that may spare patients the morbidity and risk of recurrence that accompanies potentially extensive operations.
Division of Surgical Oncology, Department of Surgery, University of California Davis Medical Center, Sacramento, California.
Jiwon Sarah
JS
Park
University of California Davis School of Medicine, Sacramento, California.
Yves-Paul
YP
Nakache
Division of Radiology, Department of Radiology, University of California Davis Medical Center, Sacramento, California.
Jeremy
J
Katz
Division of Radiology, Department of Radiology, University of California Davis Medical Center, Sacramento, California.
Robert D
RD
Boutin
Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York.
Robert J
RJ
Steffner
Division of Radiation Oncology, Department of Radiation Oncology, University of California Davis Medical Center, Sacramento, California.
Arta M
AM
Monjazeb
Division of Surgical Oncology, Department of Surgery, University of California Davis Medical Center, Sacramento, California. Electronic address: rjcanter@ucdavis.edu.
Robert J
RJ
Canter
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D018222:Desmoid Tumors; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D057832:Watchful Waiting; D055815:Young Adult
Desmoid tumors; Medical management; Observation; Recurrence; Surgery