Desmoid tümörlerde nörovasküler invazyondan korunma

Year 2013, Volume: 47 Issue: 4, 286 - 290, 18.09.2013

Harzem Ozger Okan Ozkunt Turgut Akgul Yavuz Saglam

Abstract

Desmoid tümör veya agresif fibromatozis, derin muskülo-aponevrotik yapılardan köken alan, nadir görülen, kapsülsüz, infiltratif ve lokal agresif karakterde bir tümördür. Desmoid tümörlerde tercih edilen geleneksel tedavi yöntemi geniş lokal eksizyondur. Tümörün lokal nüks oranları, yerleşim yeri ve rezeksiyon tipine bağlı olarak %15-77 arasında değişmektedir. Benzer şekilde, kurumumuzda, desmoid tümör tanısı ile opere edilen hastalarda %24 ile anlamlı bir nüks oranı görülmüştür. Birkaç kez nüks görülen desmoid tümörlerde, tekrarlayan damar ve sinir rekonstrüksiyonunu takiben amputasyon kaçınılmaz olabilmektedir. Damar ve sinir gibi canlı yapıları diğer canlı bir yapı olan tümörün invazyonundan korumak amacı ile de cansız sentetik bariyerlerin kullanılması gereksinimi doğmuştur. Bu gereksinim doğrultusunda burada sentetik damar grefti kullandığımız iki olgumuzu sunuyoruz. Tedavide sadece radyoterapinin tercih edilmediği veya lokal nüks riskinin yüksek olduğu hastalarda nörovasküler yapıların korunması sentetik damar greftlerinin kullanılması ile sağlanabilmektedir.

Keywords

Desmoid tümör; nörovasküler invazyon; greft

Preventing neurovascular invasion in desmoid tumors

Abstract

Desmoid tumors or aggressive fibromatoses are rare, non-encapsulated, infiltrative and locally aggressive tumors originating from deep musculo-aponeurotic structures. Traditionally, preferred treatment method for desmoid tumors is wide local excision. Depending on the side and type of resection, the reported local recurrence rates range from 15 to 77%. Similarly, in our institution there is a significant recurrence rate (24%) in patients who underwent surgery for desmoid tumor. After several recurrences, amputation may be inevitable following repeating vascular and nerve reconstructions. There is a need for a nonviable barrier in order to prevent the invasion of the viable tumor to the neurovascular structures which are also viable tissues. Depending on this need, we present two cases that we used synthetic vascular graft in their operations to cover neurovascular structures in order to prevent tumor invasion. For patients who are not suitable for radiotherapy and the neurovascular structures need to be secured because of the risk of local recurrence, this method can prevent possible future invasion of vessels and nerves.

Keywords

Desmoid tumor, graft, neurovascular invasion

References

• Nuyttens JJ, Rust PF, Thomas CR Jr, Turrisi AT 3rd. Surgery versus radiation therapy for patients with aggressive fibromatosis or desmoid tumors: a comparative review of 22 articles. Cancer 2000;88:1517-23.
• Sİrensen A, Keller J, Nielsen OS, Jensen OM. Treatment of aggressive fibromatosis: a retrospective study of 72 patients followed for 1-27 years. Acta Orthop Scand 2002;73:213-9.
• Enzinger FM, Weiss SW. Fibromatoses. In: Enzinger FM, Weiss SW, editors. Soft tissue tumors. 3rd ed. St. Louis: Mosby; 1995. P. 320-9.
• Lewis JJ, Boland PJ, Leung DH, Woodruff JM, Brennan MF. The enigma of desmoid tumors. Ann Surg 1993;229: 866-73.
• Mehrotra AK, Sheikh S, Aaron AD, Montgomery E, Goldblum JR. Fibromatoses of the extremities: clinicopatho- logic study of 36 cases. J Surg Oncol 2000;74:291-6.
• Posner MC, Shiu MH, Newsome JL, Hajdu SI, Gaynor JJ, Brennan MF. The desmoid tumor. Not a benign disease. Arch Surg 1989;124:191-6.
• Faulkner LB, Hajdu SI, Kher U, La Quaglia M, Exelby PR, Heller G, et al. Pediatric desmoid tumor: retrospective analy- sis of 63 cases. J Clin Oncol 1995;13:2813-8.
• Murata H, Kusuzaki K, Hirata M, Hashiguchi S, Hirasawa Y. Extraabdominal desmoid tumor with dissemination detected by thallium-201 scintigraphy. Anticancer Res 2000; 20:3963-6.
• Duggal A, Dickinson IC, Sommerville S, Gallie P. The man- agement of extra-abdominal desmoid tumours. Int Orthop 2004;28:252-6.
• Ballo MT, Zagars GK, Pollack A, Pisters PW, Pollack RA. Desmoid tumor: prognostic factors and outcome after sur- gery, radiation therapy, or combined surgery and radiation therapy. J Clin Oncol 1998;17:158-67.
• McCollough WM, Parsons JT, van der Griend R, Enneking WF, Heare T. Radiation therapy for aggressive fibromatosis. The Experience at the University of Florida. J Bone Joint Surg Am 1991;73:717-25.
• Rock MG, Pritchard DJ, Reiman HM, Soule EH, Brewster RC. Extra-abdominal desmoid tumors. J Bone Joint Surg Am 1984;66:1369-74.
• Dalén BP, Bergh PM, Gunterberg BU. Desmoid tumors: a clinical review of 30 patients with more than 20 years' fol- low-up. Acta Orthop Scand 2003;74:455-9.
• Merchant NB, Lewis JJ, Woodruff JM, Leung DH, Brennan MF. Extremity and trunk desmoid tumors: a multifactorial analysis of outcome. Cancer 1999;86:2045-52.
• Pritchard DJ, Nascimento AG, Petersen IA. Local control of extra-abdominal desmoid tumors. J Bone Joint Surg Am 1996; 78:848-54.
• Goy BW, Lee SP, Eilber F, Dorey F, Eckardt J, Fu YS, et al. The role of adjuvant radiotherapy in the treatment of resectable desmoid tumors. Int J Radiat Oncol Biol Phys 1997; 39:659-65.
• Baliski CR, Temple WJ, Arthur K, Schachar NS. Desmoid tumors: a novel approach for local control. J Surg Oncol 2002; 80:96-9.
• Ballo MT, Zagars GK, Pollack A. Radiation therapy in the management of desmoid tumors. Int J Radiat Oncol Biol Phys 1998;42:1007-14.
• Ozger H, Eralp L, Toker B, A¤ao¤lu F, Dizdar Y. Evaluation of prognostic factors affecting recurrences and disease-free survival in extra-abdominal desmoid tumors Acta Orthop Traumatol Turc 2007;41:291-4.
• Jelinek JA, Stelzer KJ, Conrad E, Bruckner J, Kliot M, Koh W, et al. The efficacy of radiotherapy as postoperative treat- ment for desmoid tumors. Int J Radiat Oncol Biol Phys 2005; 50:121-5.
• Zlotecki RA, Scarborough MT, Morris CG, Berrey BH, Lind DS, Enneking WF, et al. External beam radiotherapy for primary and adjuvant management of aggressive fibro- matosis. Int J Radiat Oncol Biol Phys 2002;54:177-81.
• Salas S, Dufresne A, Bui B, Blay JY, Terrier P, Ranchere- Vince D, et al. Prognostic factors influencing progression- free survival determined from a series of sporadic desmoid tumors: a wait-and-see policy according to tumor presenta- tion. J Clin Oncol 2011;29:3553-8.
• Shields CJ, Winter DC, Kirwan WO, Redmond HP. Desmoid tumours. Eur J Surg Oncol 2001;27:701-6.
• Spear MA, Jennings LC, Mankin HJ, Spiro IJ, Springfield DS, Gebhardt MC, et al. Individualizing management of aggressive fibromatoses. Int J Radiat Oncol Biol Phys 1998; 40:637-45.