eMedicine Specialties > General Surgery > Abdomen

Mesenteric Tumors: Treatment

Author: Neal E Seymour, MD, Associate Professor, Department of Surgery, Tufts University
Contributor Information and Disclosures

Updated: Jul 13, 2009

Treatment

Medical Therapy

  • In general, effective medical treatment for neoplastic mesenteric masses is not available. Pain and other GI complaints can be treated with analgesics and antiemetics, but these agents do not affect the underlying disease.
  • Mesenteric lymphoma is treated by cytotoxic chemotherapy.
  • Mesenteric desmoid tumors reportedly respond to sulindac therapy, hormonal manipulation, and cytotoxic chemotherapy.8

Surgical Therapy

  • In general, surgical treatment of benign mesenteric masses consists of local excision for smaller lesions and resection for bulkier tumors, provided the blood supply to the gut is not jeopardized.
  • Although the bowel can be preserved in most circumstances, resection can be quite treacherous, depending on the relationship of the lesion to larger branches of the superior mesenteric artery.
  • Most cystic mesenteric lesions can be easily excised. Resection of small intestine is rarely indicated for this problem.

Malignant mesenteric tumors

Surgical treatment is the only therapy of demonstrated benefit for these tumors. The goal of surgical treatment is removal of gross disease with a margin of normal tissue. This requires resection of any involved intestine, as well as of intestine robbed of mesenteric arterial blood supply by the dissection to remove the tumor. As in the treatment of intestinal stromal tumors or retroperitoneal sarcomas, operative management may involve en bloc resection of other involved structures.

Mesenteric desmoid tumors

These are very difficult lesions to treat surgically. Surgical treatment may increase recurrence risk, because it has been observed that desmoid tumors generally occur following abdominal surgery. Surgical debulking may be dangerous and ultimately unsuccessful and is generally reserved for patients with intestinal obstruction.8,9

Mesenteric lymphoma

In contrast to primary small bowel lymphoma, in which surgical treatment may play a valuable role in selected cases, mesenteric lymphoma is best treated with combination chemotherapy. Although some cases are diagnosed following resection of an uncharacterized mesenteric mass, surgical treatment is best used as a diagnostic tool when the diagnosis is probable but uncertain. Laparoscopy may play an important role when the procurement of tissue for diagnostic purposes is the operative goal.

Mesenteric carcinoid tumor

The treatment of this pattern of disease is to surgically resect the mesenteric masses. This procedure should be performed en bloc with any extant primary intestinal tumor. Resection of mesenteric disease should be accomplished without endangering the blood supply to normal bowel, except in the immediate area of the disease. A primary carcinoid tumor, which may be quite small and multicentric, is generally found in the resected intestinal specimen.

Castleman disease

Because this problem is nonneoplastic and generally localized, treatment consisting of resection of the lymph node mass has had good results.

Intraoperative Details

At exploration, the mass is generally found to be completely contained within the mesentery. In the case of liposarcoma, encasement of the bowel with fatty tumor tissue can occur. The gross extent of the tumor must be carefully defined in order to obtain clear margins of resection. Definition of proximity to large mesenteric blood vessels is vital. Normal intestine should be preserved to the greatest extent possible while still observing good oncologic surgical principles. If resection requires so much intestine to be removed that maintenance of nutrition cannot be expected, the patient's clinical situation (eg, age, general health) must be taken into consideration before proceeding. (See image below and Image 3.)

Resected mesenteric liposarcoma specimen. This fi...

Resected mesenteric liposarcoma specimen. This firm, fatty mass replaced a large segment of small bowel mesentery and surrounded a short segment of ileum (lower edge of specimen). The principal presenting problem was partial small bowel obstruction.

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Resected mesenteric liposarcoma specimen. This fi...

Resected mesenteric liposarcoma specimen. This firm, fatty mass replaced a large segment of small bowel mesentery and surrounded a short segment of ileum (lower edge of specimen). The principal presenting problem was partial small bowel obstruction.

Complications

Complications of surgical treatment of mesenteric masses are not specific to the disease type, except when extensive resection of solid tumors may either endanger mesenteric blood supply or when extensive small bowel resection is necessary to remove the disease. Although short-bowel syndrome is an infrequent occurrence in surgery involving the mesentery, the appropriate precautions must be taken to prevent this condition, which can result from overresection or from inadvertent damage to the blood supply to otherwise normal bowel.

More on Mesenteric Tumors

Overview: Mesenteric Tumors
Workup: Mesenteric Tumors
Treatment: Mesenteric Tumors
Follow-up: Mesenteric Tumors
Multimedia: Mesenteric Tumors
References
Further Reading
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Keywords

mesenteric tumors, mesentery, abdominal cancer, abdominal tumor, peritoneum, peritoneal, stromal tumor, GIST tumor, gastrointestinal stromal tumor, desmoid tumor, omental, lipodystrophy, leiomyosarcoma, Castleman disease, Castleman's disease, desmoid tumors, gastrointestinal stromal tumors, GIST tumors, familial adenomatous polyposis, mesenteries, abdominal tumors, stromal tumors, mesenteric mass, omentum cancer

mesenteric lymph node, mesenteric lipomas, mesenteric neoplasms, mesenteric mesotheliomas, mesenteric desmoid tumors, mesenteric lipodystrophy, retractile mesenteritis, mesenteric panniculitis, liposarcoma, lymphangiomas, lipoblastoma, peritoneal cysts, enteric cysts, hamartomas, retroperitoneal sarcomas, retroperitoneal leiomyosarcomas, intestinal obstruction, giant lymph node hyperplasia

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Contributor Information and Disclosures

Author

Neal E Seymour, MD, Associate Professor, Department of Surgery, Tufts University
Neal E Seymour, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Medical Association, American Pancreatic Association, Association for Academic Surgery, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, and Society of University Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Amy L Friedman, MD, Professor of Surgery, Director of Transplantation, State University of New York Upstate Medical University College of Medicine, Syracuse
Amy L Friedman, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Medical Women's Association, American Society for Artificial Internal Organs, American Society of Transplant Surgeons, American Society of Transplantation, Association for Academic Surgery, Association of Women Surgeons, International College of Surgeons, International Liver Transplantation Society, New York Academy of Sciences, Pennsylvania Medical Society, Philadelphia County Medical Society, Society of Critical Care Medicine, and Transplantation Society
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

 
 
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