Radical palliative surgery: new limits to pursue

Area of Science:

• Pediatric Oncology
• Surgical Oncology
• Desmoid Tumors

Background:

• Desmoid tumors are rare, locally aggressive neoplasms often requiring extensive surgical intervention.
• Recurrent desmoid tumors in pediatric patients present significant management challenges due to tumor size and location.
• Standard treatment for desmoid tumors involves en bloc resection, which can be disfiguring and functionally debilitating.

Observation:

• A 13-year-old patient presented with a massive recurrent desmoid tumor involving the abdomen, pelvis, and groin.
• En bloc resection would have necessitated hemipelvectomy and extensive abdominal wall reconstruction.
• The patient's primary goals were pain relief and improved mobility to attend school and maintain social normalcy.

Findings:

• Radical subtotal palliative resection was performed, balancing oncological control with functional preservation.
• The patient experienced significant pain reduction and improved mobility post-surgery.
• Five years after the last surgical procedure, the patient is reportedly doing well.

Implications:

• Palliative surgery can be a viable and warranted option for pediatric patients with extensive, recurrent desmoid tumors when curative resection is overly morbid.
• This approach prioritizes patient quality of life and functional outcomes, aligning with personal patient goals.
• Consideration of palliative surgical strategies may improve long-term outcomes and well-being in select pediatric oncology cases.