Uterine Leiomyosarcoma: Does the Primary Surgical Procedure Matter?

Perri, Tamar; Korach, Jacob; Sadetzki, Siegal; Oberman, Bernice; Fridman, Eduard; Ben‐Baruch, Gilad

doi:10.1111/igc.0b013e31819a1f8f

Cited by 140 publications

(80 citation statements)

References 24 publications

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“…Ovaries may be preserved in young patients with tumors confined to the uterus [2,11,12]. Intraperitoneal morcellation of uLMS is associated with poorer prognosis; endoscopic supracervical hysterectomy or tumor enucleation and morcellation should be avoided [13,14]. The incidence of pelvic and para-aortic lymph-node metastasis is low; if metastases are palpable, hematogeneous metastasis is likely so that widespread that lymphonodeectomy will not improve the prognosis and is not advisable [15].…”

Section: Surgical Therapymentioning

confidence: 99%

Uterine Leiomyosarcoma

et al. 2018

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Uterine leiomyosarcoma (uLMS) is a rare entity among malignant gynecologic tumors with a very unfavorable prognosis and the highest prevalence in the pre- and peri-menopause. Only early-stage tumors have an acceptable prognosis, provided the patient has been treated without injuring the uterus. uLMS is often diagnosed accidentally and the correct diagnosis ishampered by equivocal features similar to the far more frequent benign uterine fibroids. Surgery is the basis of therapy, and it should be done in order to remove the uterus intact. As vaginal, abdominal, and endoscopic surgery - possibly including morcellation - are the methods of choice for the treatment of uterine fibroids, pre-operatively undiagnosed leiomyosarcoma detected by pathologic examination will have a worsened prognosis. Systemic treatment and radiotherapy are of no proven value in the adjuvant setting. Thus, there is strong need for a reliable pre-operative risk score for leiomyosarcoma in order to justify diagnostic means beyond clinical routine and to choose the correct surgical pathway. The clinical problems in the diagnosis of leiomyosarcoma and treatment are exemplified by a case report of a 30-year-old childless patient. Diagnostic tools as well as treatment options in adjuvant and palliative situations are reviewed.

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Section: Surgical Therapymentioning

confidence: 99%

Uterine Leiomyosarcoma

et al. 2018

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“…The standard treatment of EOC is complete surgical staging and maximal cytoreductive surgery, followed by adjuvant chemotherapy with taxane/platinum [5,6,7]. Standard surgery includes exploration of the entire peritoneal cavity, multiple peritoneal cytology, multiple peritoneal biopsy, total hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymph node dissection, and omentectomy [5,8].…”

Section: Introductionmentioning

confidence: 99%

“…Standard surgery includes exploration of the entire peritoneal cavity, multiple peritoneal cytology, multiple peritoneal biopsy, total hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymph node dissection, and omentectomy [5,8]. …”

Section: Introductionmentioning

confidence: 99%

Fertility-Sparing Surgery for Young Women with Early-Stage Epithelial Ovarian Cancer

Nam

2013

Gynecol Obstet Invest

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Background/Aims: To discuss the latest findings on oncologic and reproductive outcomes of fertility-sparing surgery in epithelial ovarian cancer (EOC) and to suggest proper indications for this treatment. Methods: A search of Medline database was performed for articles dealing with fertility-sparing surgery for EOC published in the English literature between January 1, 1969, and October 1, 2012. Results: To date, 918 patients with EOC underwent fertility-sparing surgery; 109 (11.9%) had disease recurrence and 48 (5.2%) died of disease. Retrospective studies suggest that fertility-sparing surgery may be safely performed in young women with a strong desire to preserve fertility and with nonclear cell histology, FIGO stage IA, IC and grade 1-2 disease or clear cell histology and FIGO stage IA disease. To date, 177 patients have succeeded in achieving 242 pregnancies, resulting in 214 term (88%) and 1 preterm (0.4%) births. Miscarriage rate was about 10% (25/242) and ectopic pregnancy rate was 0.8% (2/242) after fertility-sparing surgery. No congenital anomaly has been reported. Conclusions: Although randomized controlled trials have yet to be performed, many studies have suggested that fertility-sparing surgery is safe, with promising reproductive outcomes. Cautious selection of patients is important because of 5.2% mortality and 11% recurrence after this surgery.

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“…Morcellation of unsuspected uterine sarcomas can be associated with spread of disease and decreased survival rates [9][10][11]. The same is true for variants of leiomyomas such as cellular leiomyoma, atypical leiomyoma, and smooth muscle tumors of undetermined malignant potential [12].The definitive diagnosis of these lesions is provided via histology.…”

Section: Discussionmentioning

confidence: 99%