Long-term effectiveness of “West China Classification” guided surgical treatment of desmoid-type fibromatosis in shoulder girdle_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHOU Sisi , TANG Fan , MIN Li , LUO Yi , ZHOU Yong , DUAN Hong ,  TU Chongqi

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

TU Chongqi, Email: tuchongqi@163.com

Keywords：

Shoulder girdle; desmoid-type fibromatosis; surgical approach; long-term effectiveness

DOI：

10.7507/1002-1892.201912143

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Objective To evaluate the long-term effectiveness of patients received surgical treatment under the guidance of “West China Classification” of desmoid-type fibromatosis (DTF) in the shoulder girdle.Methods The clinical data of 32 patients with DTF in the shoulder girdle admitted between June 2003 and December 2016 were retrospectively analyzed, including 14 males and 18 females, aged 14-56 years with an average age of 36.8 years. The maximum diameter of the tumor was 7-19 cm, with an average of 11.1 cm. According to the “West China Classification” of DTF in the shoulder girdle, there were 4 cases of region Ⅰ, 3 cases of region Ⅱ, 6 cases of region Ⅲ, 3 cases of region Ⅳ, 5 cases of regions Ⅰ+Ⅱ, 5 cases of regions Ⅱ+Ⅲ, and 6 cases of regions Ⅰ+Ⅱ+Ⅲ. In addition, the involvement of blood vessels and nerves was also taken into consideration for choosing a surgical approach. Finally, 12 cases were operated via anteroposterior approach (group A), 14 via posterior approach (group B), and 6 via combined anterior-posterior approach (group C). The 1993 Musculoskeletal Tumor Society (MSTS93) score (including pain, limb function, satisfaction, hand position, hand flexibility, and lifting ability), Japanese Orthopedic Association (JOA) score, range of motion (ROM) of shoulder joint (including flexion, extension, abduction, and adduction), and complications of patients in the 3 groups were recorded and compared.Results All the 32 patients were followed up 30-190 months, with an average of 94.6 months. At last follow-up, complications occurred in 5 cases (15.6%), including 2 cases (16.6%) in group A, 2 (14.3%) in group B, and 1 (16.6%) in group C. There was no significant difference in the incidence of complications among the 3 groups (P=1.000). Tumor recurrence occurred in 5 (15.6%) cases, including 1 (8.3%) case in group A, 2 (14.3%) in group B, and 1 (16.6%) in group C. No significant difference was found in the recurrence rate among the 3 groups (P=1.000). At last follow-up, MSTS93 score of pain, limb function, satisfaction, hand flexibility, and hand position in groups A and B were significantly better than those in group C (P<0.05), even though no significant difference existed between group A and group B (P>0.05). The lifting ability score in group C was significantly lower than in group A (P<0.05), and no significant difference was found between other groups (P>0.05). The JOA score and flexion, extension, abduction, and adduction activities of shoulder in groups A and B were significantly better than those in group C (P<0.05). The extension activity in group A was significantly better than that in group B (P<0.05), the flexion activity in group B was significantly better than that in group A (P<0.05). There was no significant difference in other indexes between groups A and B (P>0.05).Conclusion Taking a rational approach to fully expose and completely remove the tumor is the key point of surgical treatment for patients with DTF in the shoulder girdle. At the same time, preservation of vital structures and reconstruction of soft tissues should also be taken into consideration. Overall, surgical treatment under the guidance of “West China Classification” of DTF in the shoulder girdle has achieved satisfactory long-term effectiveness.

Citation： ZHOU Sisi, TANG Fan, MIN Li, LUO Yi, ZHOU Yong, DUAN Hong, TU Chongqi. Long-term effectiveness of “West China Classification” guided surgical treatment of desmoid-type fibromatosis in shoulder girdle. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(6): 744-750. doi: 10.7507/1002-1892.201912143 Copy

1.	Carothers AM, Rizvi H, Hasson RM, et al. Mesenchymal stromal cell mutations and wound healing contribute to the etiology of desmoid tumors. Cancer Res, 2012, 72(1): 346-355.
2.	Villalobos VM, Hall F, Jimeno A, et al. Long-term follow-up of desmoid fibromatosis treated with PF-03084014, an oral gamma secretase inhibitor. Ann Surg Oncol, 2018, 25(3): 768-775.
3.	Kasper B, Baumgarten C, Garcia J, et al. An update on the management of sporadic desmoid-type fibromatosis: a European Consensus Initiative between Sarcoma Patients EuroNet (SPAEN) and European Organization for Research and Treatment of Cancer (EORTC)/Soft Tissue and Bone Sarcoma Group (STBSG). Ann Oncol, 2017, 28(10): 2399-2408.
4.	Penel N, Chibon F, Salas S. Adult desmoid tumors: biology, management and ongoing trials. Curr Opin Oncol, 2017, 29(4): 268-274.
5.	Martínez Trufero J, Pajares Bernad I, Torres Ramón I, et al. Desmoid-type fibromatosis: who, when, and how to treat. Curr Treat Options Oncol, 2017, 18(5): 29.
6.	Peng PD, Hyder O, Mavros MN, et al. Management and recurrence patterns of desmoids tumors: a multi-institutional analysis of 211 patients. Ann Surg Oncol, 2012, 19(13): 4036-4042.
7.	Shehadeh A, Ja’afar A, Isleem U, et al. Shoulder girdle resection: surgical technique modification and introduction of a new classification system. World J Surg Oncol, 2019, 17(1): 107.
8.	Malawer MM, Meller I, Dunham WK. A new surgical classification system for shoulder-girdle resections. Analysis of 38 patients. Clin Orthop Relat Res, 1991, (267): 33-44.
9.	Tang F, Min L, Yin R, et al. Large desmoid-type fibromatosis of the shoulder girdle: operative approach selection and clinic outcome. Int Orthop, 2015, 39(2): 363-369.
10.	Turner B, Alghamdi M, Henning JW, et al. Surgical excision versus observation as initial management of desmoid tumors: A population based study. Eur J Surg Oncol, 2019, 45(4): 699-703.
11.	Enneking WF, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res, 1993, (286): 241-246.
12.	von Mehren M, Randall RL, Benhamin RS, et al. Soft tissue sarcoma, version 2.2018, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2018, 16(5): 536-563.
13.	Penel N, Le Cesne A, Bui BN, et al. Imatinib for progressive and recurrent aggressive fibromatosis (desmoid tumors): an FNCLCC/French Sarcoma Group phase Ⅱ trial with a long-term follow-up. Ann Oncol, 2011, 22(2): 452-457.
14.	Wilkinson MJ, Chan KE, Hayes AJ, et al. Surgical outcomes following resection for sporadic abdominal wall fibromatosis. Ann Surg Oncol, 2014, 21(7): 2144-2149.
15.	Crago AM, Denton B, Salas S, et al. A prognostic nomogram for prediction of recurrence in desmoid fibromatosis. Ann Surg, 2013, 258(2): 347-353.
16.	Eastley N, McCulloch T, Esler C, et al. Extra-abdominal desmoid fibromatosis: A review of management, current guidance and unanswered questions. Eur J Surg Oncol, 2016, 42(7): 1071-1083.
17.	Soto-Miranda MA, Sandoval JA, Rao B, et al. Surgical treatment of pediatric desmoid tumors. A 12-year, single-center experience. Ann Surg Oncol, 2013, 20(11): 3384-3390.
18.	Zeng WG, Zhou ZX, Liang JW, et al. Prognostic factors for desmoid tumor: a surgical series of 233 patients at a single institution. Tumour Biol, 2014, 35(8): 7513-7521.
19.	Ma D, Li S, Fu R, et al. Long-term outcomes of 47 patients with aggressive fibromatosis of the chest treated with surgery. Eur J Surg Oncol, 2016, 42(11): 1693-1698.
20.	Duggal A, Dickinson IC, Sommerville S, et al. The management of extra-abdominal desmoid tumours. Int Orthop, 2004, 28(4): 252-256.
21.	de Bruyns A, Li H, MacNeil A, et al. Evolving practice patterns over two decades (1993-2013) in the management of desmoid-type fibromatosis in British Columbia. Clin Oncol (R Coll Radiol), 2020, 32(4): e102-e110.
22.	Cates JM, Stricker TP. Surgical resection margins in desmoid-type fibromatosis: a critical reassessment. Am J Surg Pathol, 2014, 38(12): 1707-1714.
23.	Öztürk R, Arıkan ŞM, Toğral G, et al. Malignant tumors of the shoulder girdle: Surgical and functional outcomes. J Orthop Surg (Hong Kong), 2019, 27(2): 2309499019838355.
24.	卫晓恩, 张琥, 张如明, 等. 聚四氟乙烯材料在肩关节肿瘤假体功能重建中的应用. 中国修复重建外科杂志, 2009, 23(8): 1018-1020.
25.	Garvey PB, Booth JH, Baumann DP, et al. Complex reconstruction of desmoid tumor resections does not increase desmoid tumor recurrence. J Am Coll Surg, 2013, 217(3): 472-480.
26.	Ballatori SE, Hecht JL, Lozano-Calderón SA. A desmoid tumor involving the subscapularis muscle: A case report. JBJS Case Connect, 2019, 9(1): e3.
27.	Lesenský J, Mavrogenis AF, Igoumenou VG, et al. Complex surgery for locally advanced bone and soft tissue sarcomas of the shoulder girdle. Eur J Orthop Surg Traumatol, 2017, 27(6): 777-786.
28.	惠涛涛, 黎逢峰, 吴永伟, 等. 肋间动脉增压超长背阔肌皮瓣修复四肢创面. 中国修复重建外科杂志, 2018, 32(12): 1572-1575.
29.	Wang Z, Wu J, Tian X, et al. Targeted therapy of desmoid-type fibromatosis: mechanism, current situation, and future prospects. Front Med, 2019, 13(4): 427-437.
30.	Gounder MM, Mahoney MR, Van Tine BA, et al. Sorafenib for advanced and refractory desmoid tumors. N Engl J Med, 2018, 379(25): 2417-2428.

1. Carothers AM, Rizvi H, Hasson RM, et al. Mesenchymal stromal cell mutations and wound healing contribute to the etiology of desmoid tumors. Cancer Res, 2012, 72(1): 346-355.
2. Villalobos VM, Hall F, Jimeno A, et al. Long-term follow-up of desmoid fibromatosis treated with PF-03084014, an oral gamma secretase inhibitor. Ann Surg Oncol, 2018, 25(3): 768-775.
3. Kasper B, Baumgarten C, Garcia J, et al. An update on the management of sporadic desmoid-type fibromatosis: a European Consensus Initiative between Sarcoma Patients EuroNet (SPAEN) and European Organization for Research and Treatment of Cancer (EORTC)/Soft Tissue and Bone Sarcoma Group (STBSG). Ann Oncol, 2017, 28(10): 2399-2408.
4. Penel N, Chibon F, Salas S. Adult desmoid tumors: biology, management and ongoing trials. Curr Opin Oncol, 2017, 29(4): 268-274.
5. Martínez Trufero J, Pajares Bernad I, Torres Ramón I, et al. Desmoid-type fibromatosis: who, when, and how to treat. Curr Treat Options Oncol, 2017, 18(5): 29.
6. Peng PD, Hyder O, Mavros MN, et al. Management and recurrence patterns of desmoids tumors: a multi-institutional analysis of 211 patients. Ann Surg Oncol, 2012, 19(13): 4036-4042.
7. Shehadeh A, Ja’afar A, Isleem U, et al. Shoulder girdle resection: surgical technique modification and introduction of a new classification system. World J Surg Oncol, 2019, 17(1): 107.
8. Malawer MM, Meller I, Dunham WK. A new surgical classification system for shoulder-girdle resections. Analysis of 38 patients. Clin Orthop Relat Res, 1991, (267): 33-44.
9. Tang F, Min L, Yin R, et al. Large desmoid-type fibromatosis of the shoulder girdle: operative approach selection and clinic outcome. Int Orthop, 2015, 39(2): 363-369.
10. Turner B, Alghamdi M, Henning JW, et al. Surgical excision versus observation as initial management of desmoid tumors: A population based study. Eur J Surg Oncol, 2019, 45(4): 699-703.
11. Enneking WF, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res, 1993, (286): 241-246.
12. von Mehren M, Randall RL, Benhamin RS, et al. Soft tissue sarcoma, version 2.2018, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw, 2018, 16(5): 536-563.
13. Penel N, Le Cesne A, Bui BN, et al. Imatinib for progressive and recurrent aggressive fibromatosis (desmoid tumors): an FNCLCC/French Sarcoma Group phase Ⅱ trial with a long-term follow-up. Ann Oncol, 2011, 22(2): 452-457.
14. Wilkinson MJ, Chan KE, Hayes AJ, et al. Surgical outcomes following resection for sporadic abdominal wall fibromatosis. Ann Surg Oncol, 2014, 21(7): 2144-2149.
15. Crago AM, Denton B, Salas S, et al. A prognostic nomogram for prediction of recurrence in desmoid fibromatosis. Ann Surg, 2013, 258(2): 347-353.
16. Eastley N, McCulloch T, Esler C, et al. Extra-abdominal desmoid fibromatosis: A review of management, current guidance and unanswered questions. Eur J Surg Oncol, 2016, 42(7): 1071-1083.
17. Soto-Miranda MA, Sandoval JA, Rao B, et al. Surgical treatment of pediatric desmoid tumors. A 12-year, single-center experience. Ann Surg Oncol, 2013, 20(11): 3384-3390.
18. Zeng WG, Zhou ZX, Liang JW, et al. Prognostic factors for desmoid tumor: a surgical series of 233 patients at a single institution. Tumour Biol, 2014, 35(8): 7513-7521.
19. Ma D, Li S, Fu R, et al. Long-term outcomes of 47 patients with aggressive fibromatosis of the chest treated with surgery. Eur J Surg Oncol, 2016, 42(11): 1693-1698.
20. Duggal A, Dickinson IC, Sommerville S, et al. The management of extra-abdominal desmoid tumours. Int Orthop, 2004, 28(4): 252-256.
21. de Bruyns A, Li H, MacNeil A, et al. Evolving practice patterns over two decades (1993-2013) in the management of desmoid-type fibromatosis in British Columbia. Clin Oncol (R Coll Radiol), 2020, 32(4): e102-e110.
22. Cates JM, Stricker TP. Surgical resection margins in desmoid-type fibromatosis: a critical reassessment. Am J Surg Pathol, 2014, 38(12): 1707-1714.
23. Öztürk R, Arıkan ŞM, Toğral G, et al. Malignant tumors of the shoulder girdle: Surgical and functional outcomes. J Orthop Surg (Hong Kong), 2019, 27(2): 2309499019838355.
24. 卫晓恩, 张琥, 张如明, 等. 聚四氟乙烯材料在肩关节肿瘤假体功能重建中的应用. 中国修复重建外科杂志, 2009, 23(8): 1018-1020.
25. Garvey PB, Booth JH, Baumann DP, et al. Complex reconstruction of desmoid tumor resections does not increase desmoid tumor recurrence. J Am Coll Surg, 2013, 217(3): 472-480.
26. Ballatori SE, Hecht JL, Lozano-Calderón SA. A desmoid tumor involving the subscapularis muscle: A case report. JBJS Case Connect, 2019, 9(1): e3.
27. Lesenský J, Mavrogenis AF, Igoumenou VG, et al. Complex surgery for locally advanced bone and soft tissue sarcomas of the shoulder girdle. Eur J Orthop Surg Traumatol, 2017, 27(6): 777-786.
28. 惠涛涛, 黎逢峰, 吴永伟, 等. 肋间动脉增压超长背阔肌皮瓣修复四肢创面. 中国修复重建外科杂志, 2018, 32(12): 1572-1575.
29. Wang Z, Wu J, Tian X, et al. Targeted therapy of desmoid-type fibromatosis: mechanism, current situation, and future prospects. Front Med, 2019, 13(4): 427-437.
30. Gounder MM, Mahoney MR, Van Tine BA, et al. Sorafenib for advanced and refractory desmoid tumors. N Engl J Med, 2018, 379(25): 2417-2428.

Chinese Journal of Reparative and Reconstructive Surgery

Long-term effectiveness of “West China Classification” guided surgical treatment of desmoid-type fibromatosis in shoulder girdle

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