Abdominal wall desmoid tumors: A proposal for US-guided resection

Abstract

Background: Desmoid tumors (DTs) is a benign tumor with high tendency to infiltrative evolution and recurrence. Nowadays, in abdominal localization, the standard approach is surgery with R0 condition. The need to repair post-surgical wide wall defect requires conservative technique to decrease the incidence of incisional hernia and to obtain better quality of life (QoL).

Methods: We perform an abdominal wall desmoid resection using ultrasound guide. This technique ensures to spare a wide wall area and to obtain a multilayer reconstruction minimizing postoperative risk. This approach allows good oncological results and better managing abdominal wall post-resection defect.

Results: We use US guided surgery to get radical approach and wall tissue spare that allows us a multilayer reconstruction minimizing post-operative complications. No recurrences were observed in one year follow up period.

Conclusion: Our experience represents first step to consider ultrasound mediated technique usefull to optimize wall resection surgery and to minimize following complications.

Keywords: Abdominal wall; Desmoid tumor; Oncological safety; Tissue sparing; Ultrasound.

Fig. 1

Desmoid in RMN preoperative study.

Fig. 2

Preoperative US exploration.

Fig. 3

WIOUS exploration. We put the electric scalpel under the probe to detect the right point of dissection using the metal knife image on US.

Fig. 4

Surgical US guided margins: lesion radius plus 1 cm (r).

Fig. 5

All thickness infiltrative lesion resection.

Fig. 6

Different technical of lesion resection: x = lesion radius; r = lesion radius plus 1 cm in US guided resection; R = lesion radius plus 3 cm in “classical resection”.

Graphic 1

The variation of spared wall tissue area is directly depending on lesion radius. On graphic and on table is represented the relationship between radius value and relative spared area.