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Intercontinental collaborative experience with abdominal, retroperitoneal and pelvic schwannomas

Monteiro De Barros, J and Hodson, J and Glasbey, J and Massey, R and Rintoul-Hoad, O and Chetan, M and Desai, A and Almond, L M and Gourevitch, D and Ford, S J and Strauss, D and Smith, H and Hayes, A and Cardona, K and Lopez-Aguiar, A and Johnson, A and Swallow, C and Burtenshaw, S and Nessim, C and Weng, R and Purgin, B and Gronchi, A and Fiore, M and Callegaro, D and Raut, C P and Fairweather, M and Bagaria, S and Novak, M and Gyorki, D and Reid, F and Mullinax, J and Gonzalez, R J and Van Coevorden, F and Van Houdt, W and Haas, R L M and Van Boven, H and Heeres, B (2019) 'Intercontinental collaborative experience with abdominal, retroperitoneal and pelvic schwannomas.', British Journal of Surgery, 107 (4). pp. 452-563.

Abstract

Background Schwannomas are rare tumours that pose a significant management challenge in the abdomen, retroperitoneum and pelvis. No data are available to inform management strategy. Methods A collaborative international cohort study, across specialist sarcoma units, was conducted to include adults presenting between 2000 and 2017 with histopathologically confirmed schwannomas within the abdomen, retroperitoneum or pelvis. Results Of 485 patients across 12 centres, 38 (7·8 per cent) were discharged without follow-up, 199 (41·0 per cent) underwent early resection and 248 (51·1 per cent) had radiological monitoring. Of these 248 patients, 96 (38·7 per cent) eventually had surgery, giving an overall resection rate of 60·8 per cent (295 of 485). At baseline, median tumour volume was 90·1 (i.q.r. 26·5–262·0) cm3. The estimated growth rate was 10·5 (95 per cent c.i. 9·4 to 11·6) per cent per year, and was consistent in the short term (within 2 years of diagnosis) and long term (beyond 2 years) (ρ = 0·405, P = 0·021). A decision to operate was more common in symptomatic patients (P < 0·001) and for rapidly growing tumours (growth rate more than 20 per cent per year) (P = 0·025). R0/R1 resection was achieved in 91·6 per cent of patients (263 of 287). Kaplan–Meier long-term recurrence rates after R0/R1 resection were 2·3 and 6·7 per cent at 3 and 5 years respectively. Conclusion Specific recommendations include: indications for early surgery, prediction of growth from radiological monitoring, promotion of selective submacroscopic resection and cessation of postoperative imaging surveillance.

Item Type:Article
Full text:(AM) Accepted Manuscript
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Status:Peer-reviewed
Publisher Web site:https://doi.org/10.1002/bjs.11376
Publisher statement:This is a pre-copyedited, author-produced version of an article accepted for publication in British Journal of Surgery following peer review. The version of record Monteiro De Barros, J, Hodson, J, Glasbey, J, Massey, R, Rintoul-Hoad, O, Chetan, M, Desai, A, Almond, L M, Gourevitch, D, Ford, S J, Strauss, D, Smith, H, Hayes, A, Cardona, K, Lopez-Aguiar, A, Johnson, A, Swallow, C, Burtenshaw, S, Nessim, C, Weng, R, Purgin, B, Gronchi, A, Fiore, M, Callegaro, D, Raut, C P, Fairweather, M, Bagaria, S, Novak, M, Gyorki, D, Reid, F, Mullinax, J, Gonzalez, R J, Van Coevorden, F, Van Houdt, W, Haas, R L M, Van Boven, H & Heeres, B (2019). Intercontinental collaborative experience with abdominal, retroperitoneal and pelvic schwannomas. British Journal of Surgery 107(4): 452-563. is available online at: https://doi.org/10.1002/bjs.11376
Date accepted:30 August 2019
Date deposited:30 September 2021
Date of first online publication:01 March 2020
Date first made open access:30 September 2021

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