全腹腔鏡下子宮全摘出術後に診断確定した子宮平滑筋肉腫例の臨床像と治療成績の検討

抄録

Background: Uterine leiomyosarcoma (uLMS) is an aggressive soft tissue sarcoma that accounts for about 1−2% of uterine malignant tumors. It is associated with poor prognosis, and the 5-year overall survival rate is about 60−70%, even in patients at FIGO stage I of the disease. We aimed to evaluate the clinical features and outcomes of patients diagnosed with uLMS after they underwent total laparoscopic hysterectomy (TLH) for presumed benign fibroids.

Methods: We retrospectively reviewed our records of presumed benign fibroid surgeries between the years 2001 and 2017.

Results: From a total of 11,242 patients treated for benign conditions, 8 patients (0.07 %) were diagnosed with uLMS after they underwent TLH. The mean±SD age was 54±7.4 years, the median tumor size was 89 mm (28−146 mm), and four patients were premenopausal. Seven patients were diagnosed with FIGO stage I disease (IA:1 IB:6) and 1 patient with stage 3A disease. We performed the conventional vaginal hand morcellation for extraction during TLH, except in 3 of the 8 cases where we used in-bag morcellation. Power morcellation was not used in any of the cases. As adjuvant therapy, 2 patients underwent oophorectomy, while 5 patients received docetaxel/gemcitabine (DG) therapy. Three cases of recurrence were observed over a median observation period of 34 months. The site of recurrence was localized, except for one lung multiple metastases case, and there was no peritoneal dissemination or vaginal cuff recurrence of uLMS.

Conclusion: Our data suggest that TLH with vaginal hand morcellation does not increase the risk of recurrence of unsuspected uterine sarcoma. However, measures should be taken to minimize the dissemination of occult malignancy. We suggest that in-bag hand morcellation may be a reliable method for safe tissue extraction.