Excision of abdominal wall tumours and reconstruction with Marlex mesh

Because metastatic abdominal wall tumours are rare and their biologic activity is unpredictable, they must be managed aggressively (a) for potential cure of isolated recurrences and (b) to obtain good palliation, as fetid exophytic lesions alter the patient's self-image and life-style. An aggressive surgical approach often leaves a large abdominal wall defect. The authors describe 19 patients (10 men, 9 women) with these tumours who had their abdominal wall reconstructed with Marlex mesh. All patients received antibiotics preoperatively, but 16 had either mechanically unprepared bowel due to obstruction or abdominal contamination from the intestine intraoperatively. The commonest complication was wound abscess in 10 patients; it was controlled without removing the Marlex mesh. The majority of patients had prolonged palliation with greatly reduced symptoms, a reasonable quality of life and acceptable cosmesis. Potentially life-threatening intra-abdominal complications were reduced. One patient was considered cured. The authors believe that there is a definite role for aggressive surgical management of abdominal wall metastases and that Marlex mesh may be used for reconstruction even when there has been peritoneal contamination.