Rectus abdominis muscle resection for abdominal wall recurrence of mucinous adenocarcinoma or peritoneal mesothelioma

Our plain-English summary of Rectus abdominis muscle resection for abdominal wall recurrence of mucinous adenocarcinoma or peritoneal mesothelioma, by T. Yan, P. Sugarbaker (Tumori, 2008).

The study

• Authors: T. Yan, P. Sugarbaker
• Journal: Tumori
• Published: 2008;94(3):309-13
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aims And Background: Diagnostic technologies which penetrate the abdominal wall in an attempt to definitively diagnose an intraabdominal malignancy by biopsy can contaminate the abdominal wall by cancerous cells. With follow-up these entrapped cancer cells may progress as an abdominal wall recurrence of the disease process. Frequently, laparoscopy is the definitive diagnostic study which results in the abdominal wall cancer progression.

Methods: We examined recurrences within the abdominal wall and attempted to establish a surgical approach to this problem which would maximize a functional result and minimize the incidence of disease persistence within the abdominal wall.

Results: Eighteen patients with abdominal wall recurrence were studied. Laparoscopy port sites resulted in the abdominal wall disease in eight patients, in four the recurrence was at a previous ostomy site, in three it was in a Pfannenstiel incision and in three it was in a McBurney incision site. All of these patients were treated by total resection of the rectus abdominis muscle. This resulted in a complete removal of visible disease that was dissecting along the fibers of the rectus abdominis muscle.

Conclusions: No patients required reoperation for abdominal wall hernia and mesh repair was not used in any of these patients. Disease control within the abdominal wall has been excellent.

In plain English

This article from a Washington, DC, cancer program described a surgical technique and its results. It does not discuss asbestos. The patients' cancer had come back in the abdominal wall where earlier procedures had passed through it. There were 18 patients: 14 with appendiceal mucinous neoplasms and 4 with peritoneal mesothelioma. The recurrence was at a laparoscopy port site in eight patients, an ostomy site in four, a Pfannenstiel incision in three and a McBurney incision in three. All 18 were treated by what the authors called total excision of the rectus abdominis muscle; its uppermost portion was removed only if tumor extended into it. Earlier, the first three patients had a local elliptical excision down to and including the posterior rectus sheath and peritoneum; all three recurred. After a median follow-up of two years, none of the 18 patients had recurred in the abdominal wall. None needed another operation for a hernia, and no mesh was used. The authors recommended complete removal of the muscle on the affected side in nearly all patients. They noted a risk of hernia and said continued follow-up is necessary.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case series from one surgical program with a description of the surgical technique (rectus abdominis muscle resection)
• Who was studied: 18 patients with cancer recurrence in the anterior abdominal wall (14 appendiceal mucinous neoplasms, 4 peritoneal mesothelioma), treated at the Peritoneal Surface Malignancy Program, Washington Cancer Institute, Washington, DC; the treatment period is not stated
• Exposure: Asbestos exposure is not discussed. The article examined earlier procedures that went through the abdominal wall as the sites where cancer recurred: laparoscopy port sites, ostomy sites, Pfannenstiel incisions and McBurney incisions
• Main results:
  • Sites of abdominal wall recurrence among the 18 patients: laparoscopy port sites in 8, previous ostomy site in 4, Pfannenstiel incision in 3, McBurney incision in 3
  • In what the authors call total rectus abdominis muscle excision, the muscle is cut at its insertion just below the costal margin; its uppermost portion is removed only if tumor extends into it
  • In the first three patients (treated before the 18), a direct approach to the cancer nodule was used: an elliptical incision down to and including the posterior rectus sheath and peritoneum. All three recurred
  • With a median two-year follow-up, none of the 18 patients treated by total rectus abdominis muscle excision had recurred in the abdominal wall
  • No patient needed reoperation for abdominal wall hernia, and mesh repair was not used in any patient
• The authors' conclusion: The authors recommended complete removal of the rectus abdominis muscle on the affected side in nearly all patients, reporting improved results compared with the partial local excisions they had done in the past
• Limitations the authors state:
  • The authors stated that continued follow-up is necessary regarding hernia
  • The authors noted a danger of hernia formation because only one fascial layer of the abdominal wall remains after the operation

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Adenocarcinoma, Peritoneal Mesothelioma, Biopsy.

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