Different surgical strategies of patients with intravenous leiomyomatosis

Abstract

Intravenous leiomyomatosis (IVL) is a rare benign tumor. The study aimed to assess outcomes of patients treated surgically for IVL.Between November 2002 and January 2015, 76 patients were treated for IVL. The stage of IVL was evaluated preoperatively by echocardiography and enhanced computerized tomography (CT) scan, and graded into 4 stages according to intravascular tumor progression. We recorded age, lower limb edema before surgery, surgical parameters, and hospitalization expenses. Patients were followed up every 6 months and tumor recurrence was assessed by CT and ultrasound. Patients were followed up for a mean of 4.5 ± 2.5 years (range 1–13 years) and there was no operative, hospital, or long-term mortality or were lost to follow-up.The rate of lower extremity edema, amount of blood loss, postoperative transfusion, length of intensive care unit (ICU) stay, postoperative hospitalization, and hospitalization expenses differed significantly between patients at different presurgery stages. Tumors recurred in 4 of 7 patients with stage I IVL that opted for surgery that preserved the ovaries and uterus. No recurrence was observed in patients graded stage II or more, in all of which the uterus and ovaries were removed. Recurrence was observed in only 4 of 76 cases of IVL, all of whom opted for surgery that spared the ovaries and uterus.Different surgical strategies should be decided based on the staging to completely remove the tumor and ensure the safety of patients. Removal of both ovaries is necessary for inhibiting tumor growth and avoiding recurrence.

Intravenous Leiomyomatosis of the Uterus: A Retrospective Single-Center Study in 14 Cases

“…To better guide surgical strategies and standardize the operation, the classification method of Ma et al with modifications was applied to divide uterine IVL into four stages according to the disease progression [5]: stage I: lesions were confined to the pelvis; stage II: the lesion was located in iliac vein/inferior vena cava; stage III: tumor entered the right atrium/right ventricle; stage IV: the tumor reached the pulmonary artery. ere were 7 patients with stage I, including 1 patient with the lower abdominal bulge, 2 patients with increased menstruation, 1 patient with dysmenorrhea, and the remaining 3 patients with no symptoms who were checked with uterine fibroids at physical examination.…”

“…Early diagnosis of this disease is difficult owing to its insidious onset and when symptoms appear, the tumor is often involved in the right atrium and even the pulmonary artery, causing serious consequences [3]. Complete surgical resection is currently the most effective intervention for patients with IVL of the uterus [4,5]; however, the surgeries are all carried out under deep hypothermia circulation arrest combined with thoracic and abdominal incision and circulatory anesthesia, resulting in huge surgical trauma. e specific etiology of IVL is not yet clear, and there are two theories: one is that the leiomyomas originate from the uterine vein wall; second, invasion of uterine fibroids into blood vessels [6].…”

Inferior Vena Cava Syndrome of uncommon aetiology

“…In the review of the literature, the venous approach in order to remove the mass is usually performed by venotomy of the IVC directly [6,9,10]. By this approach, in stage II patients, a median of 1000cc blood loose has been reported [6]. In our case, we successfully performed the access by a common iliac left venotomy, and thereby avoiding dissecting the contralateral iliac axis, and the IVC's reflux during the extraction of the mass.…”

“…In spite of this, no thromboembolic events occurred. In the review of the literature, the venous approach in order to remove the mass is usually performed by venotomy of the IVC directly [6,9,10]. By this approach, in stage II patients, a median of 1000cc blood loose has been reported [6].…”

“…Recently Guotao Ma et al [6] in an analysis of 76 cases, they have developed a clinical stage in order to categorize the tumour's progression; stage I when is confined to pelvic cavity; stage II when it hasn't reached the renal veins, stage III when it extends into right atrium; and stage IV when it reaches the pulmonary arteries. This classification is useful in the preoperatory study in order to plan the surgery strategy.…”