Abdominal Leiomyosarcoma: Aggressive Management

Abstract

We retrospectively reviewed 34 cases of intra-abdominal leiomyosarcoma treated between 1967 and 1986. Thirty-three patients had operation, and the primary tumor was removed in all but one. Fifteen patients had peritoneal implants at initial surgical exploration; 14 had tumor recurrence and had at least one reoperation. Five-year survival was 16% overall and 37% for patients without peritoneal implants at the initial procedure. This figure includes five patients in whom distant metastases developed after benign gastric or intestinal leiomyoma was diagnosed based on histologic and gross findings. All patients who have had five-year cures or more than two years of palliation after demonstration of peritoneal metastases had operation after 1978, a finding that probably reflects a more aggressive surgical approach to these tumors. Effective palliation, defined as three months of symptom relief and six-month survival in patients with widespread intraperitoneal tumor, was achieved significantly more often when the tumor causing the symptom was resected (eight of eight patients) than when it was not (five of six patients). These data indicate that an aggressive surgical approach is warranted in attempts to achieve either cure or palliation in patients with intra-abdominal leiomyosarcoma.