Traitement chirurgical dans les tumeurs desmoïdes extra-abdominales: analyse critique d’une série de 36 patients opérés

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Oncologie (Impact Factor: 0.1). 01/2011; 13(2):109-115. DOI: 10.1007/s10269-010-1949-9

ABSTRACT IntroductionLes fibromatoses desmoïdes extra-abdominales (FDEA) sont des tumeurs bénignes rares, mais à un haut risque de récidive locale,
ce qui les distingue des autres tumeurs bénignes. Le but de ce travail était d’évaluer le taux de récidive locale, après traitement
chirurgical, afin de mieux définir les indications opératoires et les facteurs pronostiques de récidive.

MéthodeNous avons réalisé une étude rétrospective de 36 cas de tumeurs opérées dans notre établissement entre 1989 et 2008. Vingt-quatre
tumeurs ont récidivé. Les facteurs de risques évalués étaient l’âge, le sexe, la localisation de la tumeur, l’imagerie et
les marges de résection.

RésultatsCette tumeur touche surtout les femmes de la troisième ou quatrième décennie. Le principal facteur de récidive semble être
la qualité des marges de résection. L’IRM semble être utile pour prédire le potentiel de récidive de ces tumeurs après chirurgie
avec un facteur péjoratif en cas de lésions hypo-intenses en séquence T1 et hyper-intenses en T2 prenant la gadolinium.

DiscussionLa place de la chirurgie et des traitements associés (radiothérapie, chimiothérapie, tamoxifène) reste à déterminer et les
indications thérapeutiques doivent être précisées en fonction du rapport bénéfice/risque pour le patient. Enfin, la réalisation
d’une simple surveillance doit être évaluée, car de nombreuses lésions récidivantes se sont stabilisées spontanément.

Desmoid fibromatoses are a rare benign tumour but with a high rate of local recidivism. The goal of this article was to identify
the prognostic factor and to evaluate the efficacy of the surgery. We report 36 patients who underwent surgery in our department
between 1989 and 2008. Twenty-four had recidivism. This tumour primarily affects women in the third or fourth decade. The
principal prognostic factor is the margin of resection. MRI seems to be useful to predict the potential of recidivism. The
role of the surgery remains to be determined, and therapeutic indication must to be discussed with regard to benefits and
risks. Also, the “wait and see” attitude must be evaluated as this tumour stabilizes spontaneously.

Mots clésTumeur–Fibromatose desmoïde–Chirurgie
KeywordsTumor–Aggressive fibromatosis–Surgery

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