Solid Omental Tumors Treatment & Management

  • Author: Kendrix J Evans, MD; Chief Editor: John Geibel, MD, DSc, MA   more...
 
Updated: Nov 28, 2011
 

Medical Therapy

The rarity of primary omental tumors has prevented an 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, requiring a further debulking operation. The benefits of radiotherapy must be weighed against the risk of injury to abdominal viscera, particularly the bowel.

In treating GISTs, imatinib in conjunction with surgical resection is currently being advocated. Imatinib acts by inhibiting tyrosine kinase enzymes. Several trials are currently being conducted exploring the role of imatinib as an adjuvant treatment to prolong disease-free as well as overall survival. GISTs are refractory to standard chemotherapy.

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Surgical Therapy

Complete surgical excision (total omentectomy) is the recommended treatment of primary omental tumors. Even when peritoneal implants are present, omentectomy appears to significantly improve survival.

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Follow-up

Recommendations for the follow-up care of patients with solid omental tumors have not been established. Because recurrences and metastasis 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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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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Outcome and Prognosis

Patients with primary malignant tumors of the omentum have a median survival time of only 6 months. Only 10-20% of patients are alive 2 years after surgical excision. The reason for this grave prognosis is unclear because only a minority of these patients have distant metastasis at initial diagnosis.

Benign omental tumors are associated with long-term survival after surgical resection. In one series, patients with benign tumors demonstrated a 5-year survival rate of 75%. Patients with liposarcomas showed a 5-year survival rate of 59-70%. Survival depends on histology types. Round cell liposarcomas are poorly differentiated tumors with frequent metastasis and are associated with shorter 5-year survival rates.

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Future and Controversies

Complete surgical excision offers the best chance of cure. The role of adjuvant therapy in the management of malignant omental tumors is uncertain. Because of the rarity of these lesions, the effectiveness of chemotherapy and radiation therapy has not been established. Advancements in these treatment modalities may improve future survival rates for patients with malignant primary omental tumors.

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Contributor Information and Disclosures
Author

Kendrix J Evans, MD  General Surgery Resident, Keesler Military Medical Center, USAF

Kendrix J Evans, MD 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, and Christian Medical & Dental Society

Disclosure: Nothing to disclose.

Coauthor(s)

Quintessa Miller, MD  Staff Physician, Department of General Surgery, Keesler Air Force Base Medical Center

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

Disclosure: Nothing to disclose.

A Letch Kline, MD  Program Director, Department of Surgery, Keesler USAF Medical Center; 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, American Medical Association, American Society for Parenteral and Enteral Nutrition, Association for Surgical Education, Southeastern Surgical Congress, and Southwestern Surgical Congress

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

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

Disclosure: Medscape Salary Employment

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: RFA Medical None Director; MRC Biotec None Director

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 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

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 Consulting; ARdelyx Ownership interest Board membership

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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. Distribution of Primary Omental Tumors
Tumor HistologyNumber of Cases% of Total
Leiomyosarcoma2217
Hemangiopericytoma86
Sarcoma32
Myosarcoma21.5
Fibrosarcoma32
Reticulosarcoma11
Spindle cell sarcoma11
Liposarcoma11
Rhabdomyosarcoma11
Leiomyoma/leiomyoblastoma1411
Lipoma54
Fibroma32
Fibromatosis21.5
Mesothelioma21.5
Endothelioma11
Myxoma11
Neurofibroma11
Malignant fibrous histiocytoma11
Gastrointestinal stromal tumor2116
Glomus21.5
Teratoma2821
Lipoblastoma86
Total131100
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