Identical-twin small-bowel transplant for desmoid tumour

Morris, J.L.; Johnson, D; Rimmer, JohnA.P.; Kuo, P P; Alfrey, EdwardJ.; Bastidas, J. Augusto; Dafoe, DonaldC.

doi:10.1016/s0140-6736(95)91130-8

Cited by 51 publications

(21 citation statements)

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“…Large intra-abdominal desmoid tumors cannot often be excised completely without sacrificing vital structures and without attendant high perioperative mortality and major morbidity. While in the past, bowel transplantation has been performed as the only means of complete excision of such mesenteric desmoids [56][57][58], management has now become substantially more conservative, including medical treatment and even observation only, as discussed later [9,27,30]. Common complications of surgery include wound complications, loss of function, compromising appearance and complications of bowel resections.…”

Section: Surgery And/or Radiotherapymentioning

confidence: 99%

Desmoid tumors: need for an individualized approach

Bree¹,

Keus

Melissas

et al. 2009

Expert Review of Anticancer Therapy

107

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Desmoid tumor, also known as aggressive fibromatosis or desmoid-type fibromatosis, is a rare monoclonal, fibroblastic proliferation arising in musculoaponeurotic structures. Although histologically benign, desmoids are often locally invasive and associated with a high local recurrence rate after resection. Since it is a heterogeneous disease, in particular regarding clinical presentation, anatomic location and biological behavior, treatment should be individualized to reduce local tumor control failure with concurrently acceptable morbidity and preservation of quality of life. Many issues regarding optimal treatment of desmoids remain controversial. However, wide surgical excision remains the treatment of choice, except when surgery is mutilating and is associated with considerable function loss or major morbidity. Involvement of surgical margins is probably associated with an increased risk of local recurrence. Postoperative radiotherapy results in a significant reduction of the local recurrence rate, but only in the case of involved surgical margins. Radiotherapy for gross disease is considerably effective, but is associated with a relatively high rate of complications, which are usually mild or moderate and radiation dose dependent. Radiotherapy should only be applied where anatomic constraints preclude complete resection and radiotherapy is not too toxic. Risk factors for local tumor control failure include young age, large size, presentation as recurrent disease, limb/girdle or intra-abdominal location, involved surgical margins, omission of radiotherapy, radiation dose less than 50 Gy and insufficient radiation field size. Increased comprehension of the pathogenesis and biological behavior of desmoids resulted in the emerging applicability of systemic therapies and a wait-and-see policy. Systemic treatment may be indicated in patients that have anatomic barriers to effective surgery or radiotherapy. Considering the significant morbidity of surgery and/or radiotherapy for certain locations, especially mutilation and loss of function, and the tumor's natural history, which is often characterized by prolonged periods of stability or even regression, a period of watchful waiting may compose the most appropriate management in selected asymptomatic patients. Attempts to complete eradication of the disease may be worse than the disease itself.

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Section: Surgery And/or Radiotherapymentioning

confidence: 99%

Desmoid tumors: need for an individualized approach

Bree¹,

Keus

Melissas

et al. 2009

Expert Review of Anticancer Therapy

107

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“…One area that needs standardization is the length of small bowel required for successful weaning of a patient from TPN. Reports in previously published cases have described harvesting only a 60-cm segment of distal jejunum and proximal ileum or only the distal ileum, ileocecal valve, and a portion of the cecum [4,17]. However, it has been reported that 60 cm of small bowel is not long enough to free a recipient completely from TPN [4].…”

Section: Discussionmentioning

confidence: 99%

“…However, it has been reported that 60 cm of small bowel is not long enough to free a recipient completely from TPN [4]. In addition, resection of the ileum, ileocecal valve, and cecum might have an adverse impact on the function of the remaining donor bowel (e.g., increased transit time and vitamin B 12 deficiency) [17].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic harvesting of small bowel graft for small bowel transplantation

et al. 2002

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“…Recurrence is more frequent than at other sites and FAP-associated desmoids have a higher recurrence rate than sporadic desmoids even if excised completely [4]. We presented a case where aggressive surgery had been successful; there have been few cases of small bowel transplantation following excision of large mesenteric desmoids [5]. In conclusion, surgery should be avoided for mesenteric desmoids because of the risk of accelerated growth and high risk of recurrence.…”

Section: Sirmentioning

confidence: 92%

“…Obviously, SRUS must be accurately diagnosed to prevent unsuitable or even incorrect treatments. Endosonography reveals whether the rectal wall layers are intact or disrupted, and thus is helpful in excluding malignancy [5,6].…”

Section: Sirmentioning

confidence: 99%