Limits...
Radical palliative surgery: new limits to pursue.

Young-Spint M, Guner YS, Meyers FJ, Schneider P, Khatri VP - Pediatr. Surg. Int. (2009)

Bottom Line: The patient's personal goals however were to alleviate the pain and limited mobility that would allow her to re-attend high school and appear normal to her peers.Therefore, palliative surgery was pursued and currently the patient is 5 years out from her last surgery doing well.We believe that the option of surgical palliation in this case was warranted and should be an option for similar cases in the future.

View Article: PubMed Central - PubMed

Affiliation: University of California Davis School of Medicine, 2315 Stockton Blvd, Sacramento, CA 95817, USA. mindy.young-spint@ucdmc.ucdavis.edu

ABSTRACT
This case report describes the radical subtotal palliative resection of a massive recurrent desmoid tumor encompassing the abdomen, pelvis, and groin in a child who was 13 years old at the time of initial resection. Given the extensive distribution of the tumor en bloc resection, which is the standard treatment of desmoid tumors, would have meant performing a hemipelvectomy and repair of a large abdominal wall defect, likely with skin grafts and mesh. The patient's personal goals however were to alleviate the pain and limited mobility that would allow her to re-attend high school and appear normal to her peers. Therefore, palliative surgery was pursued and currently the patient is 5 years out from her last surgery doing well. We believe that the option of surgical palliation in this case was warranted and should be an option for similar cases in the future.

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Related in: MedlinePlus

Intraoperative view of the resected specimen
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Fig2: Intraoperative view of the resected specimen

Mentions: At the initial surgery, the tumor was approached through a midline incision with en bloc resection of the anterior abdominal wall. Intraoperatively, the bladder and left ureter were noted to be densely adherent to the posterior surface of the tumor. With the aid of cystoscopy, the bladder was identified and an en bloc resection of a 2 cm portion of the bladder wall and the distal part of the left ureter were completed. In addition, the adherent left fallopian tube, ovary, proximal sigmoid colon, and descending colon were removed with the specimen. Distally the dissection was taken to the left groin crease where the abdominal/pelvic tumor was contiguous with the groin mass. At this point some of the iliacus muscle was resected, and the last remnant of attachments from the pubic ramus was severed, amputating the tumor (measured 32 × 26 × 15 cm and weighed 6.1 kg; Fig. 2). The bladder was then repaired and the left ureter was reimplanted. Resection of the anterior abdominal muscle and fascia, left a defect of 17 × 17 cm, with an overlying skin defect of 9 × 9 cm (Fig. 3a).Fig. 2


Radical palliative surgery: new limits to pursue.

Young-Spint M, Guner YS, Meyers FJ, Schneider P, Khatri VP - Pediatr. Surg. Int. (2009)

Intraoperative view of the resected specimen
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2749181&req=5

Fig2: Intraoperative view of the resected specimen
Mentions: At the initial surgery, the tumor was approached through a midline incision with en bloc resection of the anterior abdominal wall. Intraoperatively, the bladder and left ureter were noted to be densely adherent to the posterior surface of the tumor. With the aid of cystoscopy, the bladder was identified and an en bloc resection of a 2 cm portion of the bladder wall and the distal part of the left ureter were completed. In addition, the adherent left fallopian tube, ovary, proximal sigmoid colon, and descending colon were removed with the specimen. Distally the dissection was taken to the left groin crease where the abdominal/pelvic tumor was contiguous with the groin mass. At this point some of the iliacus muscle was resected, and the last remnant of attachments from the pubic ramus was severed, amputating the tumor (measured 32 × 26 × 15 cm and weighed 6.1 kg; Fig. 2). The bladder was then repaired and the left ureter was reimplanted. Resection of the anterior abdominal muscle and fascia, left a defect of 17 × 17 cm, with an overlying skin defect of 9 × 9 cm (Fig. 3a).Fig. 2

Bottom Line: The patient's personal goals however were to alleviate the pain and limited mobility that would allow her to re-attend high school and appear normal to her peers.Therefore, palliative surgery was pursued and currently the patient is 5 years out from her last surgery doing well.We believe that the option of surgical palliation in this case was warranted and should be an option for similar cases in the future.

View Article: PubMed Central - PubMed

Affiliation: University of California Davis School of Medicine, 2315 Stockton Blvd, Sacramento, CA 95817, USA. mindy.young-spint@ucdmc.ucdavis.edu

ABSTRACT
This case report describes the radical subtotal palliative resection of a massive recurrent desmoid tumor encompassing the abdomen, pelvis, and groin in a child who was 13 years old at the time of initial resection. Given the extensive distribution of the tumor en bloc resection, which is the standard treatment of desmoid tumors, would have meant performing a hemipelvectomy and repair of a large abdominal wall defect, likely with skin grafts and mesh. The patient's personal goals however were to alleviate the pain and limited mobility that would allow her to re-attend high school and appear normal to her peers. Therefore, palliative surgery was pursued and currently the patient is 5 years out from her last surgery doing well. We believe that the option of surgical palliation in this case was warranted and should be an option for similar cases in the future.

Show MeSH
Related in: MedlinePlus