Surgical resection versus active surveillance for desmoid tumours at one year

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Frontiers in Medicine Published April 14, 2026 Medically reviewed April 25, 2026 DOI ↗ By Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

Key Takeaway

Consider surgical resection alongside active surveillance for desmoid tumours, as progression rates at one year appear comparable.

This retrospective cohort study analyzed 76 patients with desmoid tumours managed at the National Cancer Centre Singapore. Participants were categorized into two groups: those undergoing surgical resection (R0, R1, or R2 wide excision) and those managed with active surveillance. The primary outcome assessed was radiological disease progression at one year, with secondary outcomes including long-term results for R0 resections and recurrence management.

At one year, progressive disease occurred in 5 of 19 patients (26.3%) in the active surveillance group. In the surgical resection group, 13 of 57 patients (22.8%) experienced progressive disease. When analyzing resection subgroups, progression rates were 20% for R0 resection (5 of 25), 25% for R1 resection (7 of 28), and 25% for R2 resection (1 of 4).

Long-term follow-up for the R0 resection subgroup indicated no further progression; all recurrences stabilized or regressed. The study did not report specific adverse events, serious adverse events, discontinuations, or tolerability data. No statistical significance was reported between the groups, and the study design is observational.

The authors note that controversies regarding surgery stem from concerns about precipitating tumour growth, given the postulated role of trauma in desmoid tumour pathogenesis. This study suggests surgery achieves good disease control at one year without triggering growth, reinforcing its role as a viable option alongside active surveillance in selected patients. Limitations include the retrospective nature of the data and lack of reported safety metrics.

Study Details

Study typeCohort

EvidenceLevel 3

PublishedApr 2026

View Original Abstract ↓

IntroductionDesmoid tumours are locally aggressive, fibroblastic soft-tissue tumours which can affect adjacent structures. Management of desmoid tumours is multi-faceted and controversies surrounding surgical treatment stem from concerns about potential of surgery to precipitate tumour growth as pathogenesis of desmoid tumours is postulated to originate from trauma.MethodsData from patients with desmoid tumours treated at the National Cancer Centre Singapore between 1999 and 2023 were collected retrospectively. We reviewed and compared radiological disease progression at one year for patients undergoing active surveillance and those who had surgical resection.ResultsA total of 76 patients with desmoid tumours were seen in NCCS between September 1999 and October 2023; 19 patients were placed on active surveillance, and the remaining 57 patients underwent R0/ R1/ R2 wide excision of desmoid tumour. At one-year, progressive disease was observed in 5 out of 19 patients (26.3%) on active surveillance, and 13 out of 57 patients (22.8%) who underwent surgical resection. Progressive disease was observed in 5 out of 25 (20%) of patients following R0 resection, though no further progression occurred long-term, and all recurrences either stabilized or regressed. In the R1 group, 7 out of 28 (25%) patients showed progression at one year; management included repeat resection, cryoablation, or continued surveillance. Among R2 patients, 1 out of 4 patients had progressive disease with one patient maintaining complete radiological response at five years.ConclusionLong-term outcomes following R0 resection were notably favourable, with no further progression and evidence of tumour stability or regression in all recurrent cases. Progressive disease rates at one year were comparable between surgical and surveillance groups, supporting a tailored, risk-adapted approach to management. Surgery does not appear to trigger tumour growth and achieves good disease control at one year, reinforcing its role as a viable option alongside active surveillance in selected patients.