The surgical management of soft tissue tumours arising in the abdominal wall☆

Abstract 

Background

Soft-tissue tumours can occur at almost any site, including the abdominal wall and represent a biologically diverse group of benign and malignant tumours.

Methods

A prospectively-kept database was searched to identify all patients with tumours resected that involved the abdominal wall. The histological diagnosis, complication rates and local recurrence rates were reported. Kaplan-Meier analysis of prognostic factors was determined for patients with primary abdominal wall sarcomas.

Results

Ninety-two patients underwent resection for tumours involving the abdominal wall. Desmoid tumours (n=30) and primary soft-tissue sarcomas (n=25) were the most common pathologies. Of 92 patients undergoing resection 87 required reconstruction of the abdominal wall defect with polypropelene mesh but only 2 patients required reconstruction of the overlying skin. There were no immediate surgical complications in patients who underwent isolated abdominal wall reconstruction and the long term incision hernia rate was 4%. Kaplan-Meier analysis for patients with primary abdominal wall sarcomas showed that local recurrence was higher in tumours>10cm (p=0.0024) and in high grade tumours (p=0.0021). Disease-specific survival was worst in high grade tumours (p=0.0010) and tumours>10cm (p=0.0042). Desmoid tumours did not recur in any patient after abdominal wall resection, irrespective of microscopic margins.

Conclusions

Tumours involving the abdominal wall exhibit a wide range of pathologies. Abdominal wall reconstruction can be achieved in the vast majority of cases with mesh reconstruction alone with little surgical morbidity. Sarcomas carry a significant risk of local recurrence. Abdominal wall fibromatosis carries a better prognosis than fibromatosis arising in the extremities.

Keywords: Abdominal wall, Sarcoma, Fibromatosis, Desmoid tumour, Soft-tissue tumour, Survival