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This case report describes a 48-year-old man with FAP and a progressive abdominal wall desmoid refractory to non-operative management, including medical therapy. Surgery was performed without pursuing wide negative margins, preserving the posterior rectus sheath. 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In this case, the tumor continued to enlarge and became symptomatic despite medical therapy.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What surgical approach was used regarding margins and tissue preservation?",{"text":117,"@type":113},"The operation preserved the posterior rectus sheath and did not pursue wide negative margins. 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While active surveillance is the initial approach, surgery may be indicated for symptomatic or progressive disease; however, the optimal surgical strategy remains debated.  \nCASE PRESENTATION: We present the case of a 48-year-old man with FAP and a history of two previous laparotomies. He developed a progressive and symptomatic abdominal wall desmoid tumor refractory to non-operative management, including medical therapy. He underwent a surgical resection without pursuing wide negative margins. Intraoperatively, the tumor was adherent to the prior midline incision scar and anterior rectus sheath. After resection, the resulting 100 × 50 mm fascial defect was repaired with a synthetic mesh. Histopathology confirmed the desmoid tumor with microscopically negative (R0) resection margins, and no evidence of recurrence was observed at the 9-month follow-up.  \nCONCLUSIONS: Surgical resection without pursuing wide negative margins, previously described in sporadic desmoids, may be considered a feasible option for selected FAP-associated abdominal wall tumors, balancing local control with no apparent postoperative abdominal wall functional deficit.  \nKEYWORDS: familial adenomatous polyposis, abdominal wall desmoid, function-sparing abdominal wall surgery  \n1Department of Gastrointestinal Tract Surgery, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan  \n2Department of Gastroenterology, Kita Fukushima Medical Center, Date, Fukushima, Japan  \n3Department of Diagnostic Pathology, Fukushima Medical University School of Medicine, Fukushima, Fukushima, Japan  \n4Department of Gastroenterological Surgery, Aizu Medical Center, Fukushima Medical University, Aizu, Fukushima, Japan  \nCorresponding author: Makoto Hasegawa. Department of Gastrointestinal Tract Surgery, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima 960-1295, Japan  \nE-mail: [h-makoto@fmu.ac.jp](h-makoto@fmu.ac.jp)  \nReceived: October 6, 2025; Accepted: December 2, 2025  \nDOI: 10.70352/scrj.cr.25-0584  \n© 2025 The Author(s) . Published by Japan Surgical Society  \nThis article is licensed under a Creative Commons Attribution 4.0 International License.  \nHasegawa M. et al.  \nAbbreviations  \nERCP endoscopic retrograde cholangiopancreatography  \nESD endoscopic submucosal dissection  \nFAP familial adenomatous polyposis  \nLECS laparoscopy and endoscopy cooperative  \nsurgery  \nNSAID non-steroidal anti-inflammatory drug  \nINTRODUCTION  \nDesmoid-type fibromatosis (hereafter referred to as desmoid tumor) is a rare, locally aggressive fibroblastic neoplasm characterized by infiltrative growth and a lack of metastatic potential. 1) Desmoid tumors are predominantly sporadic, with an estimated annual incidence of 2.4–4.3 per million people, accounting for approximately 0.03% of all neoplasms and fewer than 3% of soft tissue tumors. 1)  \nA subset of desmoid tumors is associated with FAP, comprising approximately 7.5%–16% of all cases. Among patients with FAP, desmoid tumors develop in approximately 8%–20% of individuals.2,3) In FAP-associated cases, tumor locations include intra-abdominal (53%), abdominal wall (24%), and extremities (9%), with the remainder being unknown or multiple sites.2) Identified risk factors for desmoid tumor development include prior abdominal surgery, an APC","cbCaikOKRmELXpDV","https://ap.wps.com/l/cbCaikOKRmELXpDV","pdf",3122294,"English","# Case Report\n## Abstract\n## Introduction\n## Case Presentation\n## Conclusions\n## Keywords\n## Abbreviations","[{\"question\":\"Why was surgery considered for this FAP-associated abdominal wall desmoid?\",\"answer\":\"Active surveillance is preferred for asymptomatic cases, but surgery is typically reserved for symptomatic or progressive disease. In this case, the tumor continued to enlarge and became symptomatic despite medical therapy.\"},{\"question\":\"What surgical approach was used regarding margins and tissue preservation?\",\"answer\":\"The operation preserved the posterior rectus sheath and did not pursue wide negative margins. The resulting resection achieved microscopically negative (R0) margins.\"},{\"question\":\"How was the abdominal wall defect repaired after resection?\",\"answer\":\"After tumor resection, the 100 × 50 mm fascial defect was repaired using a synthetic mesh.\"}]","Surgical Resection with Posterior Rectus Sheath Preservation and Mesh Reconstruction without Pursuing Wide Negative Margins for an Abdominal Wall Desmoid in Familial Adenomatous Polyposis - A Case Report | PDF",1790710525,15]