Introduction Malignant Mixed Mullerian Tumors (MMMT) often present with very large, necrotic tumor burden in the uterus that leads to dilation and effacement of the cervix. In patients with this presentation, conventional hysterectomy poses a much greater challenge as the ureters are comprised by the mass of the tumor and are at an increased risk for injury. Given this surgical challenge, many of these patients may begin with neoadjuvant chemoradiation. However, these treatment modalities are associated with significant toxicity and negatively impact patient quality of life. Therefore, we present a minimally invasive robotic surgical approach that aims to optimize quality of life without sacrificing prognosis.
Description The patient had biopsy proven MMMT. Pre-operative CT scan showed an enlarged uterus with no evidence of extrauterine disease. On presentation, the cervix was dilated and effaced with extruding disease. Disease was initially reduced transvaginally. Robotic approach included 1) upfront vascular control of pedicles, 2) radical hysterectomy with complete dissection of the ureters secondary to the dilated and effaced cervix, 3) infracollic omentectomy, 4) lymph node dissection, and 5) appendectomy.
Conclusion The patient was debulked to zero residual disease. She was discharged the following day ad had no post-operative complications. A robotic approach for staging and complete cytoreduction of bulky Malignant Mixed Mullerian Tumors is feasible with good postoperative outcome.
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