Our Summary

This research paper discusses the difficulties in treating a type of tumor called a “giant neurofibroma”. These tumors are hard to deal with because they have a lot of irregular blood vessels and can cause dangerous bleeding during surgery. The large size of the tumors also makes it hard to repair the area after the tumor has been removed.

Usually, surgeons don’t remove the whole tumor because of these risks. Instead, they take out a part of it, a process known as “subtotal resection” or “debulking”. But this approach has its own issues; it leads to a high chance of the tumor coming back, and can actually increase the risk of serious bleeding.

In this study, the researchers looked back at 9 patients who had these large tumors, with sizes ranging from 12 x 9 cm to 60 x 70 cm. Before surgery, they used imaging techniques to understand the characteristics of the tumor. They then performed “radical resection”, meaning they removed the entire tumor. The amount of blood lost during surgery ranged from 300 to 2600 mL.

After the tumor was removed, the area was repaired using a piece of skin from the thigh in 2 patients, and skin grafts in the other 7. Some patients experienced skin death, but this could be addressed by changing the dressing and using nearby healthy skin.

During the follow-up period (12-39 months), none of the patients had their tumor come back. This suggests that removing the entire tumor is a good approach. They also found that reusing the patient’s own skin was a good way to cover the large area after surgery, without causing additional problems. Therefore, they concluded that it’s possible to remove the tumor and repair the wound in a single surgery.

FAQs

  1. What are the challenges involved in the management of giant neurofibroma?
  2. Why is subtotal resection or debulking not always the best approach for treating giant neurofibroma?
  3. How effective is the radical resection treatment strategy for giant neurofibroma?

Doctor’s Tip

A helpful tip a doctor might tell a patient about tumor resection is to make sure to follow your post-operative care instructions carefully, including keeping the surgical site clean and dry, avoiding strenuous activity, and attending all follow-up appointments. It is also important to report any unusual symptoms or signs of infection to your healthcare provider promptly. Following these recommendations can help ensure a successful recovery and reduce the risk of complications.

Suitable For

Patients with giant neurofibroma are typically recommended tumor resection, specifically radical resection, due to the high rate of recurrence associated with subtotal resection or debulking. Patients with tumors that are large in size and have abundant malformed vessels are at risk for life-threatening hemorrhage during operation. Radical resection not only reduces the risk of recurrence, but also decreases the surgical risk associated with subtotal resection or debulking. In this study, 9 patients with giant neurofibroma underwent radical resection with successful outcomes, demonstrating the effectiveness of this treatment strategy.

Timeline

Before tumor resection:

  • Preoperative angiography and magnetic resonance imaging scanning are performed to clarify the tumor features.
  • Surgical team plans for radical resection of the giant neurofibroma.
  • Patient undergoes surgery for tumor resection, with in-operation blood loss ranging from 300 to 2600 mL.
  • Resection defects are repaired using anterolateral thigh free flap or skin grafts.
  • Postoperative care involves monitoring for complications such as skin necrosis and ensuring proper wound healing.

After tumor resection:

  • Patients undergo routine follow-up appointments for 12-39 months to monitor for tumor recurrence.
  • No tumor recurrence is recorded during follow-up, indicating the effectiveness of radical resection in preventing recurrence.
  • Patients may experience partial skin necrosis, which can be managed by changing dressings and allowing adjacent survived skin to repair the necrosis area.
  • Overall, the treatment strategy of radical resection for giant neurofibroma proves effective in preventing tumor recurrence and achieving successful wound repair in one stage.

What to Ask Your Doctor

  1. What is the size and location of the tumor?
  2. What are the potential risks and complications of tumor resection?
  3. What is the likelihood of tumor recurrence after resection?
  4. What imaging tests will be done before the surgery to assess the tumor?
  5. What surgical technique will be used for the resection?
  6. How will the resection defect be repaired after surgery?
  7. What is the expected recovery time and rehabilitation process after tumor resection?
  8. Will further treatment, such as radiation or chemotherapy, be needed after resection?
  9. How often will follow-up appointments be needed to monitor for recurrence or complications?

Reference

Authors: Liu F, Din F, Gu C, Lv L, Wang X, Luo X, Sun D, Yang J. Journal: Ann Plast Surg. 2020 Oct;85(4):413-418. doi: 10.1097/SAP.0000000000002250. PMID: 31985538