Hystérectomies pour léiomyomes présumés : la crainte du léiomyosarcome doit-elle faire appréhender la voie d’abord chirurgicale autre que laparotomique ?

Cost-Effectiveness Analysis of Morcellation Hysterectomy for Myomas

“…Minimally invasive surgery has been shown to result in a decrease in blood loss, transfusions, pulmonary complications, infections, thromboembolic events, hospital stay, postoperative pain, and death, with improvement in quality of life, body image, and return to baseline function [42]. For these reasons, a minimally invasive approach with the aid of morcellation is preferred by surgeons and patients alike.…”

Intrapelvic dissemination of early low-grade endometrioid stromal sarcoma due to electronic morcellation

“…Recently, the FDA warned that laparoscopic morcellation poses a risk of spreading unsuspected uterine sarcomas, when used for a hysterectomy or myomectomy in women with presumed uterine myomas [ 5 ]. However, the most prevalent opposing view [ 9 ] is derived from the low incidence (approximately 0.28%) of unsuspected uterine sarcoma during myomectomy for presumed myoma [ 4 5 6 ]. Given the extremely low prevalence of sarcoma in a series of laparoscopic surgeries performed for presumed myomas, and the lack of a specific diagnostic method to differentiate between the two, gynecological surgeons are faced with the dilemma of whether all surgeries performed for presumed myomas should be carried out via a non-laparoscopic surgical route [ 9 ].…”

Uterine C-Kit positive low grade stromal sarcoma

“…[5] Their symptomatology is non-specific and they are characterized by histopathological diversity. [1] A literature review showed that around 50 cases of Uterine C-Kit positive stromal sarcomas had been documented. [5–8]…”

“…[8] Due to its rarity, the proper treatment consensus has not yet evolved and hence, early diagnosis is essential, as the patients’ survival is correlated to the tumor stage. [1] These tumors are characterized by their resistance to chemotherapy and radiation treatment. Surgery is the primary modality of treatment, but for patients with unresectable disease, alternate therapeutic options are clearly necessary.…”

“…[1] Of these subtypes very few cases of Stromal C-Kit positive tumors have been documented. These stromal C-Kit positive uterine sarcomas are characterized by their resistance to chemotherapy and radiation treatment.…”