Cytoreductive Surgery and HIPEC as a Treatment Option for Laparoscopic Resection of Uterine Leiomyosarcoma with Morcellation: Early Results
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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.
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.
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.
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.
KeywordsSarcoma Peritoneal Metastasis Laparoscopic Resection Uterine Fibroid Peritoneal Cancer Index
Paul Sugarbaker, Chukwuemeka Ihemelandu, and Lana Bijelic have no conflicts of interest to declare.
- 1.US FDA. Quantitative assessment of the prevalence of unsuspected uterine sarcoma in women undergoing treatment of uterine fibroids: summary and key findings. Silver Spring: US FDA. 2014. http://www.fda.gov/downloads/MedicalDevices/Safety/AlertsandNotices/UCM393589.pdf. Accessed 5 Dec 2014.
- 2.Sugarbaker PH. An overview of peritonectomy, visceral resections, and perioperative chemotherapy for peritoneal surface malignancy. In: Sugarbaker PH editor. Cytoreductive surgery and perioperative chemotherapy for peritoneal surface malignancy. Textbook and video atlas. Woodbury: Cine-Med Publishing; 2012. p. 1–30.Google Scholar
- 4.Jacquet P, Sugarbaker PH. Current methodologies for clinical assessment of patients with peritoneal carcinomatosis. J Exp Clin Cancer Res. 1996;15:49–58.Google Scholar
- 6.Sugarbaker PH. Intraperitoneal doxorubicin: rationale, pharmacokinetic studies, and clinical results. In: Pache M editor. Doxorubicin: biosynthesis, clinical uses and health implications. New York: Nova Science Publishers; 2014. p. 1–20.Google Scholar
- 13.Sugarbaker PH. Sarcomatosis and imitanib-resistant gistosis: diagnosis and therapeutic options. In: Sugarbaker PH editor. Cytoreductive surgery and perioperative chemotherapy for peritoneal surface malignancy. Textbook and video atlas. Woodbury: Cine-Med Publishing; 2012. P. 127–36.Google Scholar
- 17.Sugarbaker PH, van der Speeten K, Stuart OA, Chang D, Mahteme H. Patient- and treatment-related variables, adverse events and their statistical relationship for treatment of peritoneal metastases. In: Sugarbaker PH editor. Cytoreductive surgery and perioperative chemotherapy for peritoneal surface malignancy. Textbook and video atlas. Woodbury: Cine-Med Publishing; 2012. p. 183–206.Google Scholar