Intravenous leiomyomatosis of the uterus: Preoperative and intraoperative assessment

Abstract

ObjectiveTo assess factors influencing preoperative diagnosis and hemorrhage during surgery with uterine intravenous leiomyomatosis.MethodsThis retrospective single‐institution study used univariate analysis and multivariate models to investigate potential factors contributing to preoperative diagnosis and hemorrhage during surgery associated with intravenous leiomyomatosis in 135 patients from January 2012 to April 2022. Risk factors for disease recurrence were also investigated. The SPSS statistical analysis package was used for data analysis.ResultsPrevious myomectomy or fibroid ablation and tumor location on color Doppler were related to preoperative diagnosis (P = 0.031 and P = 0.003, respectively). Multivariate regression analysis demonstrated that lesions extending to the broad ligament were the only factors affecting preoperative diagnosis (odds ratio [OR] 5.383, 95% confidence interval [CI] 1.49–19.47). Univariate analysis showed that previous myomectomy or fibroid ablation (P = 0.017), tumor location (P = 0.027), and parauterine involvement (P = 0.014) were associated with intraoperative hemorrhage. Parauterine involvement was an independent risk factor for increased bleeding (OR 1.36, 95% CI 1.14–3.92). Six patients (4.4%) relapsed. The present study demonstrated that age (P = 0.031) and surgical type (P < 0.001) might be associated with disease recurrence.ConclusionsTreatment emphasis should focus on lesions extending to the broad ligament. Intraoperative bleeding associated with parauterine involvement should be stopped as effectively as possible.

Magnetic resonance imaging findings of intravascular leiomyomatosis of the uterus: a case report

“…Hence, it is imperative to prioritize individuals whose color ultrasound results indicate broad ligament lesions. Meanwhile pelvic MRI should be actively performed to improve the preoperative diagnosis rate, evaluate the degree of disease progression, and ensure adequate preoperative preparation ( 20 ).…”

“…Parauterine involvement was an independent risk factor for increased intraoperative bleeding ( 20 ). Gao and Qu ( 20 ) demonstrated that age (<45 year) and surgical type (myomectomy) might be associated with disease recurrence.…”

“…Parauterine involvement was an independent risk factor for increased intraoperative bleeding ( 20 ). Gao and Qu ( 20 ) demonstrated that age (<45 year) and surgical type (myomectomy) might be associated with disease recurrence. A few risk factors of recurrence are identified such as initial voluminous mass (>7 cm), impairment of broad ligament or failure of total surgical resection, as has been observed by Yu et al ( 23 ).…”