Secondary cytoreductive surgery potentially improves the oncological outcomes of patients with recurrent uterine sarcomas

Nakamura, Kenichi; Kajiyama, Hiroaki; Utsumi, Fumi; Suzuki, Shiro; Niimi, Keiko; Sekiya, Ryuichiro; Sakata, Jun; Yamamoto, Eiko; Shibata, Kiyosumi; Kikkawa, Fumitaka

doi:10.3892/mco.2018.1560

Cited by 6 publications

(7 citation statements)

References 21 publications

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“…Studies have demonstrated that the patients with recurrent uterine sarcomas who underwent secondary cytoreductive surgery had longer overall survival and disease-free intervals following the initial relapse when compared with those treated with chemotherapy or radiotherapy alone. Surgery for extrapulmonary recurrences of uterine sarcomas is limited [9]. Chemotherapy with or without palliative radiation therapy is generally recommended for patients with Stages II and III disease, incompletely resected, or metastatic disease [10].…”

Section: Discussionmentioning

confidence: 99%

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Excision of abdominal wall recurrence of uterine leiomyosarcoma: A case report

Punneshetty¹,

Chandy²,

Ete³

et al. 2021

IJCR

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The literature on management of recurrent/metastatic uterine leiomyosarcomas is limited and metastasis to the abdominal wall is very rare. We operated on a 46-year-old woman who had a total abdominal hysterectomy elsewhere for a uterine tumor and presented with recurrence to the anterior abdominal wall, 9 months after the primary surgery. There were two large ulcerated abdominal wall masses. The challenge after complete excision of the tumor was to reconstruct the abdominal wall. We were able to close the defect with a dual mesh and a fasciocutaneous flap from the anterolateral thigh. She received adjuvant chemotherapy with gemcitabine and docetaxel. At the completion of chemotherapy, she was well and apparently disease free. She recurred in the left inguinal node after 9 months but responded to oral pazopanib followed by chemotherapy. This case report highlights the rare possibility of abdominal wall metastasis after initial surgery for leiomyosarcoma. It shows that good quality of life can be achieved by a multidisciplinary treatment of abdominal wall metastasis of uterine leiomyosarcoma.

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Section: Discussionmentioning

confidence: 99%

“…Secondary cytoreduction may be considered, as neither chemotherapy nor radiation improved outcomes in recurrent disease [12]. Secondary cytoreduction is associated with prolonged survival in patients with isolated disease recurrence and long progression-free interval from the primary disease [9,13].…”

Section: Discussionmentioning

confidence: 99%

Excision of abdominal wall recurrence of uterine leiomyosarcoma: A case report

Punneshetty¹,

Chandy²,

Ete³

et al. 2021

IJCR

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“…Most patients in our series underwent cytoreduction to no residual disease with favorable peri-operative outcomes and encouraging results in terms of survival, when compared with other Original Article series. [9][10][11][12][13][14] Lastly, this study represents one of the largest series of secondary cytoreductive surgery for recurrent uterine leiomyosarcoma in the literature as well as one of the longest follow-up times (online supplementary Table 3). We also recognize the limitations of our study in that it is a retrospective study without a comparison with an analogous group of patients receiving chemotherapy only.…”

Section: Discussionmentioning

confidence: 99%

“…6 Although in a considerable number of patients the disease recurs within the pelvis, some women present with upper abdominal or intra-parenchymal (liver or pulmonary) disease. 9 Evidence in the literature on the management of recurrent uterine leiomyosarcoma is limited and mainly supports the role of secondary cytoreductive surgery, [9][10][11][12][13][14] which can be limited by disease diffusion. In particular, the heterogeneity of tumor histotypes, number of cases, and different rates of cytoreduction represent limitations of previous studies.…”

Section: Introductionmentioning

confidence: 99%

Secondary cytoreductive surgery in recurrent uterine leiomyosarcoma: a multi-institutional study

Bizzarri

Ghirardi

Fiore

et al. 2019

Int J Gynecol Cancer

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IntroductionUterine leiomyosarcoma (uLMS) represents a rare gynecological malignancy with high incidence of recurrence. Evidence in literature about the management of recurrent uLMS is limited, and the role of secondary cytoreduction has been evaluated in small and heterogeneous populations. The objective of this study is to assess the prognostic role of secondary cytoreductive surgery and its related complications in a large and homogeneous group of patients.MethodsAll consecutive patients who underwent surgery for recurrent uLMS between 01/2010-01/2018 at four Italian tertiary referral centers, were included. Relevant demographic and clinico-pathologic data were retrieved. Survival curves were estimated by Kaplan-Meier method and compared by log-rank test. Cox-proportional hazard model was used to assess the effect of the most predictive prognostic variables.Results38 patients with recurrent uLMS were treated with secondary cytoreductive surgery in the study period. Recurrence presented as isolated disease in 17 (44.7%) cases. Bowel, bladder and upper abdominal surgery was performed in 50.0%, 18.4% and 28.9% of the cases, respectively. No residual tumor was the final surgical result in 35 (92.1%) patients. Median hospital stay was 7 days (range, 1-24). No women had major intra-operative and 4 (33.3%) had major post-operative complications. No patient died within 30-days from the secondary cytoreduction. Median time to the first cycle of adjuvant chemotherapy was 41-days (range, 29-78). Median recurrence-free survival was 16.0months (95%CI,11.6 to 26.1). 5-year overall survival (OS) was 76% (95%CI,53 to 89%). Time to first recurrence >12months significantly affected OS (p=0.04).DiscussionSecondary cytoreduction in recurrent uLMS often requires complex and extensive surgical procedures. Referral to tertiary centers guarantees low peri-operative morbidity, short length of hospitalization and median time to chemotherapy within the standard of care. Therefore, secondary cytoreduction to no residual disease is an option that may be considered in recurrent uLMS, especially in patients with time to first recurrence >12months.

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“…The same result was achieved in a more recent Japanese retrospective study, which included 18 women with recurrent uterine sarcoma. They found that secondary cytoreductive surgery led to a survival advantage in this group of patients [45].…”

Section: Role Of Surgery In Gynaecological Sarcomasmentioning

confidence: 99%

Role of surgery in gynaecological sarcomas

et al. 2019

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Gynaecological sarcomas account for 3-4% of all gynaecological malignancies and have a poorer prognosis compared to gynaecological carcinomas. Pivotal treatment for early-stage uterine sarcoma is represented by total hysterectomy. Whereas oophorectomy provides survival advantage in endometrial stromal sarcoma is still controversial. When the disease is confined to the uterus, systematic pelvic and para-aortic lymphadenectomy is not recommended. Removal of enlarged lymph-nodes is indicated in case of disseminated or recurrent disease, where debulking surgery is considered the standard of care. Fertility sparing surgery for uterine leiomyosarcoma is not supported by strong evidence, whilst available data on fertility sparing treatment for endometrial stromal sarcoma are more promising. For ovarian sarcomas, in the absence of specific data, it is reasonable to adapt recommendations existing for uterine sarcomas, also regarding the role of lymphadenectomy in both early and advanced stage disease. Specific recommendations on cervical sarcomas' surgery are lacking. Existing data on surgical approach vary from radical hysterectomy to fertility-preserving surgery in the form of trachelectomy or wide local excision, however no definite conclusions can be drafted on the recommended surgical approach. For vulval sarcomas, complete surgical excision with at least 2 cm of free margin is considered to be the primary treatment which is associated with good prognosis. The aim of this review is to provide highest quality evidence to guide gynaecologic oncologists throughout surgical management of gynaecological sarcomas.

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Secondary cytoreductive surgery potentially improves the oncological outcomes of patients with recurrent uterine sarcomas

Cited by 6 publications

References 21 publications

Excision of abdominal wall recurrence of uterine leiomyosarcoma: A case report

Excision of abdominal wall recurrence of uterine leiomyosarcoma: A case report

Secondary cytoreductive surgery in recurrent uterine leiomyosarcoma: a multi-institutional study

Role of surgery in gynaecological sarcomas

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