Fernandez M, Bell T, Tumminello B, Khan S, Zhou S, Oton AB. Burden of surgery in desmoid tumors. Poster presented at the ISPOR 2023 Conference; May 7, 2023. Boston, MA. [abstract] Value Health. 2023 Jun; 26(6 supplement):S22. doi: 10.1016/j.jval.2023.03.117

OBJECTIVES: Desmoid tumors (DTs) infiltrate into surrounding structures with ill-defined margins. The aim of this research was to assess the burden of surgery in patients with DTs, focusing on rates of recurrences after surgery and functional deficits resulting from surgery, including limb amputation.

METHODS: We searched the literature from the past 1 O years to identify publications describing recurrence rates and functional outcomes post-surgery in patients with DTs. Given the lack of economic data related to DT surgeries, reviews of soft tissue sarcoma surgery costs and amputation general costs were also conducted.

RESULTS: Key risk factors identified for recurrence after surgery are young age ( < 30 years), tumor location (extremity), tumor size(> 5 cm in greatest diameter), positive resection margins, and history of trauma near the primary tumor site. DTs in the extremities have the highest risk of recurrence after surgery (29.6%-45.5%). Some studies have reported an increase in major functional limitations in patients with DTs in the limbs after surgical resections of their tumors, with > 40% suffering functional loss or amputation of the involved limb. Lifetime all-cause (including any condition being treated) direct costs for lower-extremity amputation is about one million 2022 USD. Patients undergoing more aggressive local treatments reported the lowest functioning scores. As a result of adverse outcomes reported after surgery for DT and emerging systemic treatments or active surveillance as acceptable control of the tumor, the use of surgery as initial treatment has decreased during the last 10 years (from 90.9% to 35.7% in the case of abdominal wall tumors).

CONCLUSIONS: Although surgery may be effective in some cases, it can be associated with poor longterm functional outcomes and high economic costs. Alternative treatments with significant efficacy and acceptable safety profiles that preserve limb function and improve quality of life are needed for DT patients.

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