title: Long-Term Survival in a Patient With Abdominal Sarcomatosis From Uterine Leiomyosarcoma: Role of Repeated Laparoscopic Surgery in Treatment and Follow-Up.
abstract: Uterine leiomyosarcoma (LMS) in some cases may disseminate through the abdominal cavity, without extra-abdominal spreading, determining a condition of abdominal sarcomatosis, which represents a peculiar situation. Only radical surgical removal offers a chance of long-term survival in such cases of LMS. Here we describe a case of diffuse abdominal sarcomatosis from uterine LMS in a 51-year-old perimenopausal woman who underwent laparoscopic radical hysterectomy, bilateral salpingo-oophorectomy, total pelvic peritonectomy, pelvic lymphadenectomy to the mesenteric inferior artery, and omentectomy. Then, given the high probability of disease recurrence, the patient underwent a close follow-up consisting of positron emission tomography (PET)/computed tomography every 3 months and diagnostic (and if necessary operative) laparoscopy every 6 months. To date, the patient had 11 laparoscopies; 5 of them were preceded by a PET indicative of the presence of disease with high metabolic activity, which was confirmed at surgery and each time completely removed laparoscopically with no evidence of residual disease. To date, 5 years from diagnosis the patient is alive and continues her follow-up. Our report brings to light the ability of laparoscopic surgery to obtain disease control in a case of LMS with abdominal dissemination. Moreover, laparoscopic surgery, as demonstrated in our case, may have an important role in the close follow-up of the disease and allow a timely and early radical surgical approach of relapses before they become extremely large and difficult to remove radically.
authors.affiliation: Department of Gynecologic Oncology, Azienda Ospedaliera Brotzu, Italy. Electronic address: a.maccio@tin.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Macciò
authors.affiliation: Department of Gynecologic Oncology, Azienda Ospedaliera Brotzu, Italy.
authors.forename: Paraskevas
authors.initials: P
authors.lastname: Kotsonis
authors.affiliation: Department of Gynecologic Oncology, Azienda Ospedaliera Brotzu, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Chiappe
authors.affiliation: Department of Nuclear Medicine, Azienda Ospedaliera Brotzu, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Melis
authors.affiliation: Department of General Surgery, Azienda Ospedaliera Brotzu, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Zamboni
authors.affiliation: Department of Medical Sciences M. Aresu, University of Cagliari, Italy.
authors.forename: Clelia
authors.initials: C
authors.lastname: Madeddu
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging; D000359:Aftercare; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D010535:Laparoscopy / Q000379:methods; D007890:Leiomyosarcoma / Q000601:surgery*; D008197:Lymph Node Excision; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D010052:Ovariectomy; D000072078:Positron Emission Tomography Computed Tomography; D012086:Reoperation; D058994:Salpingectomy; D012509:Sarcoma / Q000000981:diagnostic imaging / Q000601:surgery*; D017741:Survivors; D014594:Uterine Neoplasms / Q000601:surgery*
keywords: Abdominal sarcomatosis; Laparoscopy; Leiomyosarcoma; Quality of life