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Annals of Surgical Oncology

, Volume 23, Issue 5, pp 1501–1507 | Cite as

Cytoreductive Surgery and HIPEC as a Treatment Option for Laparoscopic Resection of Uterine Leiomyosarcoma with Morcellation: Early Results

  • Paul SugarbakerEmail author
  • Chukwuemeka Ihemelandu
  • Lana Bijelic
Gastrointestinal Oncology

Abstract

Background

A new and frequently utilized treatment option for symptomatic uterine leiomyoma is laparoscopic resection with morcellation so the specimen can be extracted through a small abdominal incision or through the vagina. Some of these tumors (approximately 0.2 %) have malignant foci of uterine leiomyosarcoma (ULMS) that is widely disseminated in the process of resection. These patients are in need of effective additional treatments.

Methods

Patients with ULMS were treated with a standardized cytoreductive surgery (CRS), hyperthermic perioperative chemotherapy (HIPEC), and early postoperative intraperitoneal chemotherapy (EPIC) specifically designed for sarcomatosis. Distribution of disease by Peritoneal Cancer Index was recorded by preoperative computed tomography or magnetic resonance imaging and at the time of CRS. Completeness of cytoreduction score was determined after completion of CRS. Morbidity and mortality, as well as interval to start systemic chemotherapy, were prospectively recorded.

Results

Six patients with disseminated ULMS after morcellation or slicing underwent CRS and HIPEC plus EPIC. All six patients had complete visible clearing of sarcoma prior to perioperative chemotherapy. Early intervention after morcellation was associated with a lesser extent of disease. No serious morbidity or mortality was observed in early referral patients, and patients eligible for systemic chemotherapy were treated with perioperative chemotherapy within 6 weeks of the CRS.

Conclusions

The future use of laparoscopic resection of ULMS with morcellation is currently under debate. However, patients after laparoscopic resection and morcellation have CRS and HIPEC plus EPIC as a treatment option. Results regarding short-term benefit are suggested by these early data, especially with early referral.

Keywords

Sarcoma Peritoneal Metastasis Laparoscopic Resection Uterine Fibroid Peritoneal Cancer Index 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Disclosure

Paul Sugarbaker, Chukwuemeka Ihemelandu, and Lana Bijelic have no conflicts of interest to declare.

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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Paul Sugarbaker
    • 1
    Email author
  • Chukwuemeka Ihemelandu
    • 1
  • Lana Bijelic
    • 2
  1. 1.Center for Gastrointestinal MalignanciesMedStar Washington Cancer InstituteWashingtonUSA
  2. 2.Surgical Oncology, Department of SurgeryInova Fairfax Medical CampusFalls ChurchUSA

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