A Case of Recurrent Uterine Leiomyosarcoma Treated with Complete Laparoscopic Resection

Abstract

Video Objective Uterine leiomyosarcoma (uLMS) is aggressive mesenchymal neoplasm and is associated with a high risk of recurrence and poor prognosis. The 5year overall survival rate is about 60% even in FIGO stage I disease. There is no firm evidence of chemotherapy, so surgical resection should be considered to control the disease in case of localized recurrence. We will report a case underwent total laparoscopic complete resection for recurrent mass involved sigmoid colon and right ureter. Setting Gynecology and Obstetrics department of a general hospital. Interventions The patient was a 56-year-old woman underwent total laparoscopic hysterectomy with bilateral salpingo-oophorectomy for enlarged 9cm cervical leiomyoma. The pathological examination of the uterus resected showed cytologic atypia,nuclear mitoses and coagulative necrosis, she was diagnosed as primary uLMS, stageⅠB. She rejected to receive adjuvant chemotherapy. After 7months, the isolated metastasis in pelvic and lung was suspected. Magnetic resonance imaging revealed that the 4cm tumor possibly be involved sigmoid colon and right lower ureter. Resection of the recurrent mass with segmental bowel resection and partial resection of ureter with ureteroneocystotomy was performed laparoscopically without any complications. Complete tumor resection with histologic negative margins was achieved. She had postoperative adjuvant chemotherapy with doxorubicinfor 6 cycles and additional surgery for lung meta is scheduled. Also, we experienced another three salvage cases with successful resection in combination with laparoscope and thoracoscope. Conclusion The surgical indications for recurrent uLMS should be selected, but the complete resection of localized recurrence may lead to control the disease. Minimally invasive approach may be one of the feasibleoption.