Recurrence and prognostic factors in patients with aggressive fibromatosis. The role of radical surgery and its limitations

Background: Surgery is still the standard treatment for aggressive fibromatosis (AF); however, localcontrol remains a significant problem and the impact of R0 surgery on cumulative recurrence(CR) is objective of contradictory reports. Methods: This is a single-institution study of 62 consecutive patients affected by extra-abdominal andintra-abdominal AF who received macroscopically radical surgery within a time period of 15years. Results: Definitive pathology examination confirmed an R0 situation in 49 patients and an R1 in 13patients. Five-year CR for patients who underwent R0 vs R1 surgery was 7.1% vs 46.4%(P = 0.04) and for limbs vs other localizations 33.3% vs 9.9% (P = 0.02) respectively. In 17patients who had intraoperative frozen section (IFS) margin evaluation R0 surgery was morecommon (17 of 17 vs 32 of 45, P = 0.01) and CR lower (five-year CR 0% vs 19.1%,respectively, P = 0.04). However, in multivariate analysis only limb localization showed anegative impact on CR (HR: 1.708, 95% CI 1.03 to 2.84, P = 0.04). Conclusions: IFS evaluation could help the surgeon to achieve R0 surgery in AF. Non-surgical treatment,including watchful follow-up, could be indicated for patients with limb AF localization,because of their high risk of recurrence even after R0 surgery.

via World Journal of Surgical Oncology