Sugarbaker Paul, Ihemelandu Chukwuemeka, Bijelic Lana
Center for Gastrointestinal Malignancies, MedStar Washington Cancer Institute, Washington, DC, USA.
Surgical Oncology, Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA.
Ann Surg Oncol. 2016 May;23(5):1501-7. doi: 10.1245/s10434-015-4960-y. Epub 2015 Nov 6.
A new and frequently utilized treatment option for symptomatic uterine leiomyoma is laparoscopic resection with morcellation so the specimen can be extracted through a small abdominal incision or through the vagina. Some of these tumors (approximately 0.2 %) have malignant foci of uterine leiomyosarcoma (ULMS) that is widely disseminated in the process of resection. These patients are in need of effective additional treatments.
Patients with ULMS were treated with a standardized cytoreductive surgery (CRS), hyperthermic perioperative chemotherapy (HIPEC), and early postoperative intraperitoneal chemotherapy (EPIC) specifically designed for sarcomatosis. Distribution of disease by Peritoneal Cancer Index was recorded by preoperative computed tomography or magnetic resonance imaging and at the time of CRS. Completeness of cytoreduction score was determined after completion of CRS. Morbidity and mortality, as well as interval to start systemic chemotherapy, were prospectively recorded.
Six patients with disseminated ULMS after morcellation or slicing underwent CRS and HIPEC plus EPIC. All six patients had complete visible clearing of sarcoma prior to perioperative chemotherapy. Early intervention after morcellation was associated with a lesser extent of disease. No serious morbidity or mortality was observed in early referral patients, and patients eligible for systemic chemotherapy were treated with perioperative chemotherapy within 6 weeks of the CRS.
The future use of laparoscopic resection of ULMS with morcellation is currently under debate. However, patients after laparoscopic resection and morcellation have CRS and HIPEC plus EPIC as a treatment option. Results regarding short-term benefit are suggested by these early data, especially with early referral.
对于有症状的子宫平滑肌瘤，一种新的且常用的治疗选择是腹腔镜切除并粉碎术，这样标本可通过小腹部切口或经阴道取出。其中一些肿瘤（约0.2%）存在子宫平滑肌肉瘤（ULMS）的恶性病灶，在切除过程中会广泛播散。这些患者需要有效的额外治疗。
对ULMS患者采用标准化的细胞减灭术（CRS）、围手术期热化疗（HIPEC）以及专门为肉瘤病设计的术后早期腹腔内化疗（EPIC）进行治疗。术前通过计算机断层扫描或磁共振成像以及在CRS时记录根据腹膜癌指数的疾病分布情况。CRS完成后确定细胞减灭评分的完整性。前瞻性记录发病率、死亡率以及开始全身化疗的间隔时间。
6例粉碎或切片后发生播散性ULMS的患者接受了CRS、HIPEC加EPIC治疗。所有6例患者在围手术期化疗前肉瘤均完全可见清除。粉碎术后的早期干预与疾病范围较小有关。早期转诊患者未观察到严重的发病率或死亡率，符合全身化疗条件的患者在CRS后6周内接受了围手术期化疗。
目前对于未来使用腹腔镜切除并粉碎ULMS存在争议。然而，腹腔镜切除并粉碎术后的患者有CRS、HIPEC加EPIC作为一种治疗选择。这些早期数据提示了关于短期获益的结果，尤其是早期转诊的情况。
