(P 364) TRENDS IN SURGICAL MANAGEMENT OF DESMOID TUMOR IN THE VETERANS AFFAIRS (VA) NATIONAL DATABASE

Objective: Surgery is no longer recommended for the management of desmoid tumors (DT) in most clinical scenarios because it is associated with morbidity and high local recurrence rates. An evolving understanding of the natural history of DT has resulted in a shift to active surveillance for asymptomatic or minimally symptomatic, non-morbid or non-progressive DTs, while systemic treatment options, such as nirogacestat, should be considered first-line if treatment is warranted.

The purpose of this study was to characterize the utilization and timing s of surgical management for DT following initial diagnosis, using the national VA database.

Methods: Surgical pathology notes from 2003 to 2024 were searched to identify histopathologic diagnoses of DT and the earliest date of the core needle or excisional biopsy was used as the date of DT diagnosis. Charts were manually reviewed to determine time to subsequent operative management.

Results: 270 patients were identified who had DT confirmed by histopathology. Anatomic location varied: 29% abdominal wall; 34% chest wall; 19% extremities/ girdles; 27% head/ neck; and 21% intraabdominal.

Sixty-five (24%) patients underwent surgery following the initial diagnosis. Among the group who underwent surgery for DT, 56 (86%) had one surgery, five (8%) had two, two (3%) had three, one (2%) had four, and one (2%) had six. For patients who received surgery, the median time from initial diagnosis to first surgery was 84 days (interquartile range 32-220) and greater than 75% of the surgeries happened within the first year of diagnosis.

Conclusion: The majority of patients who received surgery were operated on within three months of initial diagnosis. The early surgery suggests there may be a gap between guideline recommended active surveillance and real-world practice within the VA. Further analyses will focus on understanding how surgical practices may have changed over time, to reflect more recent guideline recommendations.