title: Cytoreductive Surgery and HIPEC as a Treatment Option for Laparoscopic Resection of Uterine Leiomyosarcoma with Morcellation: Early Results.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Center for Gastrointestinal Malignancies, MedStar Washington Cancer Institute, Washington, DC, USA. paul.sugarbaker@medstar.net.
authors.forename: Paul
authors.initials: P
authors.lastname: Sugarbaker
authors.affiliation: Center for Gastrointestinal Malignancies, MedStar Washington Cancer Institute, Washington, DC, USA.
authors.forename: Chukwuemeka
authors.initials: C
authors.lastname: Ihemelandu
authors.affiliation: Surgical Oncology, Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA.
authors.forename: Lana
authors.initials: L
authors.lastname: Bijelic
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D010535:Laparoscopy / Q000379:methods*; D007890:Leiomyosarcoma / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D000069577:Morcellation / Q000379:methods; D060787:Neoplasm Grading; D010534:Peritoneal Neoplasms / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D012509:Sarcoma / Q000517:prevention & control*; D015996:Survival Rate; D014594:Uterine Neoplasms / Q000473:pathology / Q000628:therapy*