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Solid Omental Tumors Treatment & Management

  • Author: Kendrix J Evans, MD, MS; Chief Editor: John Geibel, MD, DSc, MSc, MA  more...
 
Updated: Aug 10, 2015
 

Medical Therapy

The rarity of primary omental tumors hinders adequate assessment of adjuvant therapy. Some reports have suggested that chemotherapy may be effective.

In the treatment of malignant hemangiopericytoma, several groups have observed that doxorubicin, either alone or in conjunction with other agents, can achieve response rates of up to 80%.[28]  A 12-month course of adjuvant chemotherapy with doxorubicin, cytotoxin, and dimethyltriazenoimidazolecarboxamide (DTIC) has been suggested for the treatment of fibrosarcoma. In treating leiomyosarcoma, combination chemotherapy with hydroxyurea, etoposide, and dacarbazine has been used. Other agents used include intraperitoneal cisplatin with intravenous administration of ifosfamide and pirarubicin hydrochloride.

Radiotherapy is reportedly effective for partially excised tumors or inoperable tumors. In one study, 50 Gy was used to treat a partially excised liposarcoma. The tumor recurred after several months, necessitating a further debulking operation. The benefits of radiotherapy must be weighed against the risk of injury to abdominal viscera, particularly the bowel.

For treatment of gastrointestinal (GI) stromal tumors (GISTs), which are refractory to standard chemotherapy, imatinib in conjunction with surgical resection has been advocated.[29, 30, 31] Imatinib acts by inhibiting tyrosine kinase enzymes. Several trials have been initiated to explore the role of imatinib as an adjuvant treatment for prolonging disease-free survival, as well as overall survival. Recurrence is a concern after treatment with adjuvant imatinib. Risk factors for GIST recurrence include high tumor mitotic count, nongastric location, large size, rupture, and adjuvant imatinib for 12 months.[32]

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Surgical Therapy

Indications and contraindications

Two main indications for surgery exist: diagnosis and treatment. One of the hallmarks of omental tumors is the inability of preoperative studies to identify specific pathologic entities. As noted (see Workup), preoperative fine-needle aspiration (FNA) and core-needle biopsies are controversial for diagnostic purposes in this setting.

With respect to therapy, complete surgical excision (total omentectomy) is the recommended treatment of primary omental tumors. Even when peritoneal implants are present, omentectomy appears to improve survival significantly. Solid omental tumors can also manifest rapidly because of bleeding or intestinal infarction, requiring emergent surgery.

Absolute contraindications for surgical resection include inability to safely resect the tumor because of local invasion.

Complications

Most of the surgical procedures do not involve intestinal resections or resection of major organs. As a result, expected postoperative complications mirror those of other clean abdominal procedures. If intestinal resection is performed, the rate of infectious complications increases similar to that of clean-contaminated procedures. Other possible complications include bleeding, pancreatitis, bowel obstruction, and intestinal ischemia.

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Long-Term Monitoring

Recommendations for the follow-up care of patients with solid omental tumors have not been established. Because recurrences and metastases can occur more than 20 years after primary treatments for sarcomas, the authors recommend long-term follow-up care for these patients.

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Contributor Information and Disclosures
Author

Kendrix J Evans, MD, MS Resident Physician, Department of General Surgery, University of Utah School of Medicine

Kendrix J Evans, MD, MS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Medical Student Association/Foundation, Association of Military Surgeons of the US, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Coauthor(s)

A Letch Kline, MD Chief, Academic Affliations, Gulf Coast Veterans Health Care System; Clinical Assistant Professor, Department of Surgery, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine

A Letch Kline, MD is a member of the following medical societies: American College of Chest Physicians, American College of Surgeons, Southeastern Surgical Congress

Disclosure: Nothing to disclose.

Quintessa Miller, MD 

Quintessa Miller, MD is a member of the following medical societies: American College of Surgeons, National Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

David L Morris, MD, PhD, FRACS Professor, Department of Surgery, St George Hospital, University of New South Wales, Australia

David L Morris, MD, PhD, FRACS is a member of the following medical societies: British Society of Gastroenterology

Disclosure: Received none from RFA Medical for director; Received none from MRC Biotec for director.

Chief Editor

John Geibel, MD, DSc, MSc, MA Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital; American Gastroenterological Association Fellow

John Geibel, MD, DSc, MSc, 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, Society for Surgery of the Alimentary Tract

Disclosure: Received royalty from AMGEN for consulting; Received ownership interest from Ardelyx for consulting.

Additional Contributors

Juan B Ochoa, MD Assistant Professor, Department of Surgery, University of Pittsburgh School of Medicine; Medical and Scientific Director, HCN, Nestle Healthcare Nutrition

Disclosure: Nothing to disclose.

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Diagram of subdivisions of the omentum. The greater omentum is attached to the caudal border of the greater curvature of the stomach and consists of the hepatoduodenal, gastrocolic, and gastrosplenic ligaments. The lesser omentum is divisible into 2 parts: the hepatogastric ligament and the hepatoduodenal ligament.
The anterior double-layered fold of the greater omentum descends from the stomach and the first part of the duodenum in front of the small intestine and ascends behind itself as far as the transverse colon.
Table 1. Distribution of Primary Omental Tumors
Tumor Histology Number of Cases % of Total
Leiomyosarcoma 22 17
Hemangiopericytoma 8 6
Sarcoma 3 2
Myosarcoma 2 1.5
Fibrosarcoma 3 2
Reticulosarcoma 1 1
Spindle cell sarcoma 1 1
Liposarcoma 1 1
Rhabdomyosarcoma 1 1
Leiomyoma/leiomyoblastoma 14 11
Lipoma 5 4
Fibroma 3 2
Fibromatosis 2 1.5
Mesothelioma 2 1.5
Endothelioma 1 1
Myxoma 1 1
Neurofibroma 1 1
Malignant fibrous histiocytoma 1 1
Gastrointestinal stromal tumor 21 16
Glomus 2 1.5
Teratoma 28 21
Lipoblastoma 8 6
Total 131 100
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