Department of Medical and Surgical Sciences and Translational Medicine, PhD Course in 'Translational Medicine and Oncology', Sapienza University, Rome, Italy.
Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy.
Eur J Obstet Gynecol Reprod Biol. 2023 Aug;287:166-170. doi: 10.1016/j.ejogrb.2023.06.016. Epub 2023 Jun 17.
This review aims to provide a comprehensive description of surgical approaches for the management of uterine sarcomas. Uterine sarcomas are rare uterine neoplasms. Frequently, diagnosis is made after hysterectomy or myomectomy scheduled for presumed benign leiomyomas. The gold standard for surgical treatment of uterine sarcomas is hysterectomy with bilateral salpingo-oophorectomy. It is possible to adopt a fertility-sparing approach for those patients who wish to maintain their fertility. The role of pelvic lymphadenectomy is controversial; in fact, removal of lymph nodes is only recommended in the case of radiological suspicion of nodal involvement. Use of a morcellator is associated with increased risk of total recurrence, intra-abdominal recurrence and death. Advanced disease management should be customized based on the patient's performance status given the uncertain role of adjuvant chemotherapy. Treatment of advanced or recurrent disease remains a subject of debate, but surgery is the best approach in terms of morbidity and mortality. There are few options for management of these uterine tumours, and further studies are needed to clarify the diagnostic and therapeutic pathways of patients with a first diagnosis of uterine sarcoma and patients with relapse of uterine sarcoma. No specific evidence supports the adoption of adjuvant therapy in uterine-confined disease, and molecular/genomic profiling may be useful to identify patients at risk of recurrence.
这篇综述旨在全面描述子宫肉瘤的手术治疗方法。子宫肉瘤是一种罕见的子宫肿瘤。通常，在因疑似良性平滑肌瘤而进行子宫切除术或子宫肌瘤剔除术时，才做出诊断。子宫肉瘤的手术治疗金标准是子宫切除术加双侧输卵管卵巢切除术。对于那些希望保持生育能力的患者，可以采用保留生育力的方法。盆腔淋巴结切除术的作用存在争议；事实上，只有在影像学怀疑淋巴结受累的情况下才建议切除淋巴结。使用组织碎切器会增加总复发、腹内复发和死亡的风险。鉴于辅助化疗作用的不确定性，晚期疾病的管理应根据患者的体能状态进行个体化定制。晚期或复发性疾病的治疗仍然存在争议，但就发病率和死亡率而言，手术是最佳方法。这些子宫肿瘤的治疗选择很少，需要进一步的研究来阐明首次诊断为子宫肉瘤的患者和复发性子宫肉瘤患者的诊断和治疗途径。没有具体的证据支持在子宫局限性疾病中采用辅助治疗，而分子/基因组分析可能有助于识别有复发风险的患者。
