Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic.
Int J Gynecol Cancer. 2023 May 1;33(5):701-706. doi: 10.1136/ijgc-2022-004038.
The aim of this study was to analyze the clinical and reproductive outcomes of patients treated with myomectomy who were histologically diagnosed with uterine smooth muscle tumor of uncertain malignant potential (STUMP).
Patients who were diagnosed with STUMP and underwent a myomectomy at our institution between October 2003 and October 2019 were identified. Variables of interest obtained from the institution's database included patient age, relevant medical history, pre-operative appearance of the tumor on ultrasound, parameters of the surgical procedure, histopathological analysis of the tumor, post-operative clinical course, and course of follow-up, including reinterventions and fertility outcomes.
There were a total of 46 patients that fulfilled the criteria of STUMP. The median patient age was 36 years (range, 18-48 years) and the mean follow-up was 47.6 months (range, 7-149 months). Thirty-four patients underwent primary laparoscopic procedures. Power morcellation was used for specimen extraction in 19 cases (55.9% of laparoscopic procedures). Endobag retrieval was used in nine patients and six procedures were converted to an open approach due to the suspicious peri-operative appearance of the tumor. Five patients underwent elective laparotomy due to the size and/or number of tumors; three patients had vaginal myomectomy; two patients had the tumor removed during planned cesarean section; and two underwent hysteroscopic resection.There were 13 reinterventions (five myomectomies and eight hysterectomies) with benign histology in 11 cases and STUMP histology in two cases (4.3% of all patients). We did not observe any recurrence as leiomyosarcoma or other uterine malignancy. We did not observe any deaths related to the diagnosis. Twenty-two pregnancies were recorded among 17 women, which resulted in 18 uncomplicated deliveries (17 by cesarean section and one vaginal), two missed abortions, and two pregnancy terminations.
Our study found that uterus-saving procedures and fertility-preservation strategies in women with STUMP are feasible, safe, and seem to be associated with a low risk of malignant recurrence, even while maintaining the mini-invasive laparoscopic approach.
本研究旨在分析经组织学诊断为子宫平滑肌肿瘤不确定恶性潜能（STUMP）而行肌瘤切除术的患者的临床和生殖结局。
本研究回顾性分析 2003 年 10 月至 2019 年 10 月在我院行肌瘤切除术且组织学诊断为 STUMP 的患者。从医院数据库中获取的感兴趣变量包括患者年龄、相关病史、术前超声肿瘤表现、手术参数、肿瘤组织病理学分析、术后临床过程以及随访过程，包括再次干预和生育结局。
共有 46 例患者符合 STUMP 标准。患者中位年龄为 36 岁（范围 18-48 岁），平均随访时间为 47.6 个月（范围 7-149 个月）。34 例患者行初次腹腔镜手术，其中 19 例（55.9%的腹腔镜手术）采用电力外科切除术切除标本。9 例采用内袋回收，6 例因术中肿瘤外观可疑而转为开腹手术。5 例因肿瘤大小和/或数量行择期剖腹手术，3 例经阴道行子宫肌瘤切除术，2 例在计划剖宫产时切除肿瘤，2 例行宫腔镜切除术。13 例患者（5 例肌瘤切除术和 8 例子宫切除术）行再次干预，其中 11 例组织学良性，2 例 STUMP 组织学（所有患者的 4.3%）。我们未观察到任何肉瘤或其他子宫恶性肿瘤的复发。我们未观察到与诊断相关的死亡。17 名女性中有 22 例妊娠，其中 18 例无并发症分娩（17 例剖宫产，1 例阴道分娩），2 例流产，2 例终止妊娠。
我们的研究发现，对于 STUMP 患者，保留子宫的手术和生育力保护策略是可行的、安全的，且似乎与恶性复发风险低相关，即使保持微创腹腔镜方法。
