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Original Article
Secondary cytoreductive surgery in recurrent uterine leiomyosarcoma: a multi-institutional study
  1. Nicolò Bizzarri1,2,
  2. Valentina Ghirardi1,2,
  3. Giacomo Lorenzo Maria Di Fiore1,2,
  4. Pierandrea De Iaco3,
  5. Angiolo Gadducci4,
  6. Jvan Casarin5,
  7. Anna Myriam Perrone6,
  8. Tina Pasciuto7,
  9. Giovanni Scambia1,2 and
  10. Anna Fagotti1,2
  1. 1Division of Gynecologic Oncology, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
  2. 2Università Cattolica del Sacro Cuore, Roma, Italy
  3. 3Department of General Surgery and Gynecologic Oncology Unit, Azienda Ospedaliero-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Emilia-Romagna, Italy
  4. 4Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, Universita degli Studi di Pisa, Pisa, Toscana, Italy
  5. 5Department of Obstetrics and Gynecology, Universita degli Studi dell'Insubria, Varese, Lombardia, Italy
  6. 6Department of General Surgery and Gynecologic Oncology Unit, Azienda Ospedaliero-Universitaria di Bologna Policlinico S. Orsola-Malpighi, Bologna, Italy
  7. 7Statistics Technology Archiving Research (STAR) Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
  1. Correspondence to Professor Giovanni Scambia,Division of Gynecologic Oncology, Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy; giovanni.scambia{at}policlinicogemelli.it

Abstract

Introduction Uterine leiomyosarcoma (uLMS) represents a rare gynecological malignancy with high incidence of recurrence. Evidence in literature about the management of recurrent uLMS is limited, and the role of secondary cytoreduction has been evaluated in small and heterogeneous populations. The objective of this study is to assess the prognostic role of secondary cytoreductive surgery and its related complications in a large and homogeneous group of patients.

Methods All consecutive patients who underwent surgery for recurrent uLMS between 01/2010-01/2018 at four Italian tertiary referral centers, were included. Relevant demographic and clinico-pathologic data were retrieved. Survival curves were estimated by Kaplan-Meier method and compared by log-rank test. Cox-proportional hazard model was used to assess the effect of the most predictive prognostic variables.

Results 38 patients with recurrent uLMS were treated with secondary cytoreductive surgery in the study period. Recurrence presented as isolated disease in 17 (44.7%) cases. Bowel, bladder and upper abdominal surgery was performed in 50.0%, 18.4% and 28.9% of the cases, respectively. No residual tumor was the final surgical result in 35 (92.1%) patients. Median hospital stay was 7 days (range, 1-24). No women had major intra-operative and 4 (33.3%) had major post-operative complications. No patient died within 30-days from the secondary cytoreduction. Median time to the first cycle of adjuvant chemotherapy was 41-days (range, 29-78). Median recurrence-free survival was 16.0months (95%CI,11.6 to 26.1). 5-year overall survival (OS) was 76% (95%CI,53 to 89%). Time to first recurrence >12months significantly affected OS (p=0.04).

Discussion Secondary cytoreduction in recurrent uLMS often requires complex and extensive surgical procedures. Referral to tertiary centers guarantees low peri-operative morbidity, short length of hospitalization and median time to chemotherapy within the standard of care. Therefore, secondary cytoreduction to no residual disease is an option that may be considered in recurrent uLMS, especially in patients with time to first recurrence >12months.

  • sarcoma
  • neoplasm recurrence, local
  • surgical oncology
  • postoperative complications

https://doi.org/10.1136/ijgc-2019-000355

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    Footnotes

    • Presented at The results of this study were given as a poster presentation at the European Society of Gynaecological Oncology (ESGO) State of the Art Conference 2018 on 'New insights in rare gynaecological malignancies' held in Lyon, France, 4-6 October 2018.

    • Contributors All authors approved the final version of the manuscript. NB: data curation, methodology, writing original draft. VG: data curation, methodology, conceptualization. GLMDF: data curation, methodology. PDI: data curation, methodology, review and editing. AG: data curation, methodology, review and editing. JC: data curation, methodology, review and editing. AMP: data curation, methodology, review and editing. TP: data curation, methodology, formal analysis. GS: conceptualization, review and editing. AF: conceptualization, methodology, review and editing, writing original draft.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.