Evaluating the impact of surgical resection on desmoid tumour growth: a retrospective analysis from the National Cancer Centre Singapore

Introduction: Desmoid tumours are locally aggressive, fibroblastic soft-tissue tumours which can affect adjacent structures. Management of desmoid tumours is multi-faceted and controversies surrounding surgical treatment stem from concerns about potential of surgery to precipitate tumour growth as pathogenesis of desmoid tumours is postulated to originate from trauma. Methods: Data from patients with desmoid tumours treated at the National Cancer Centre Singapore between 1999 and 2023 were collected retrospectively. We reviewed and compared radiological disease progression at one year for patients undergoing active surveillance and those who had surgical resection. Results: A total of 76 patients with desmoid tumours were seen in NCCS between September 1999 and October 2023; 19 patients were placed on active surveillance, and the remaining 57 patients underwent R0/ R1/ R2 wide excision of desmoid tumour. At one-year, progressive disease was observed in 5 out of 19 patients (26.3%) on active surveillance, and 13 out of 57 patients (22.8%) who underwent surgical resection. Progressive disease was observed in 5 out of 25 (20%) of patients following R0 resection, though no further progression occurred long-term, and all recurrences either stabilized or regressed. In the R1 group, 7 out of 28 (25%) patients showed progression at one year; management included repeat resection, cryoablation, or continued surveillance. Among R2 patients, 1 out of 4 patients had progressive disease with one patient maintaining complete radiological response at five years. Conclusion: Long-term outcomes following R0 resection were notably favourable, with no further progression and evidence of tumour stability or regression in all recurrent cases. Progressive disease rates at one year were comparable between surgical and surveillance groups, supporting a tailored, risk-adapted approach to management. Surgery does not appear to trigger tumour growth and achieves good disease control at one year, reinforcing its role as a viable option alongside active surveillance in selected patients.