Full thickness abdominal wall resection for recurrent and metastatic neoplasms. A report of three cases

Full thickness infiltration of the abdominal wall by intraabdominal cancer, especially after effective prior therapy, is frequently considered a sign of inoperability. Such patients are treated with irradiation, chemotherapy, or locally destructive means (laser, cryosurgery) with limited success. Full thickness resection of portions of the abdominal wall has not been widely used in such settings because of concerns regarding abdominal wall reconstruction and also because of the perceived noncurative nature of such "radical" procedures. While long-term prognosis in patients with abdominal wall infiltration by cancer depends upon various factors, technical considerations regarding reconstruction need not prevent effective local palliative therapy. Bridging large defects can be successfully accomplished by using available synthetic material of a durable, inert nature. Polyprophylene (Marlex) mesh, a readily available and inexpensive inert fabric, meets all desirable features for such use. This paper details the successful treatment of three patients in whom recurrent carcinoma infiltrated the full thickness of the abdominal wall and caused intractable pain. In all three, full thickness portions of the abdominal wall were resected, segments of intestine and of urinary bladder were also excised, and the defects were closed using a double layer of polypropylene mesh. Complete relief of pain was accomplished and the cosmetic and functional results were excellent. Illustration A depicts procedure in patients one and two. Illustration B depicts procedure in patient three.