The online version of this article (doi:10.1186/1477-7819-10-184) contains supplementary material, which is available to authorized users.
All of the authors of this manuscript declared that no financial or non-financial interests were related to this study or future application after publication.
EBe was responsible for manuscript writing and study design. AT, AC and RB gave comments and revised the manuscript. PM, EBo and BB were responsible for data acquisition and analysis. GV, GM and GC were in charge of correction of the manuscript, while TD, FV and BA collaborated on the whole project design. All authors read and approved the final manuscript.
Surgery is still the standard treatment for aggressive fibromatosis (AF); however, local control remains a significant problem and the impact of R0 surgery on cumulative recurrence (CR) is objective of contradictory reports.
This is a single-institution study of 62 consecutive patients affected by extra-abdominal and intra-abdominal AF who received macroscopically radical surgery within a time period of 15 years.
Definitive pathology examination confirmed an R0 situation in 49 patients and an R1 in 13 patients. 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 17 patients who had intraoperative frozen section (IFS) margin evaluation R0 surgery was more common (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 a negative impact on CR (HR: 1.708, 95% CI 1.03 to 2.84, P = 0.04).
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.
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- Recurrence and prognostic factors in patients with aggressive fibromatosis. The role of radical surgery and its limitations
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