• Jun-Qiang Yin, Yi-Wei Fu, Zhen-Hua Gao, Chang-Ye Zou, Xian-Biao Xie, Bo Wang, Zhi-Hai Zhong, Gang Huang, and Jing-Nan Shen.
• Department of Orthopedic Oncology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
• Neurosurgery. 2021 May 13; 88 (6): 1095-1102.

BackgroundMore effective therapies are needed to treat progressive desmoid tumors when active surveillance and systemic therapy fail.ObjectiveTo assess the efficacy and safety of sandwich isolation surgery on the local control of progressive desmoid tumors involving neurovascular bundles.MethodsA total of 27 patients with progressive desmoid tumors at extremities involving neurovascular bundles who received surgery at our hospital between August 2014 and August 2018 were identified. A total of 13 patients received sandwich isolation surgery, in which R2 resection was performed in neurovasculature-involving regions, and a biomaterial patch was used to envelop involved neurovascular structures and isolate residual tumors. In non-neurovasculature-involving regions, wide resection was performed without isolation. A total of 14 patients received traditional surgery, which included tumor resection without isolation procedure.ResultsIn sandwich isolation group, tumor progressions and local recurrences occurred in 3 patients outside the isolated neurovasculature-involving regions. However, no progressions or recurrences occurred in any patients in the isolated neurovasculature-involving regions where R2 resection was performed. Sandwich isolation surgery group and traditional surgery group shared similar baseline clinical characteristics. The estimated 3-yr event-free survival rate was 76.9% after sandwich isolation surgery, and 32.7% after traditional surgery (P = .025). Patients who received sandwich isolation surgery were less likely to have local recurrence (hazard ratio: 0.257, P = .040). No complications were noted except intermittent mild pain in operative regions (2 cases).ConclusionSandwich isolation surgery is effective and safe for local control of desmoid tumors involving neurovascular bundles.© Congress of Neurological Surgeons 2021.

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