Management of Intravenous Leiomyomatosis With Intracaval and Intracardiac Extension

Wang, Jinhui; Yang, Jiaxin; Huang, Huifang; Li, Yuan; Miao, Qi; Lü, Xin; Li, Yongjun; Yang, Ning; Huang, Yuguang; Chen, Jie; Cao, Dongyan; Wu, Ming; Pan, Lingya; Lang, Jinghe; Shen, Keng

doi:10.1097/aog.0b013e31826ebb90

Cited by 50 publications

(34 citation statements)

References 17 publications

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“…[11] Currently, the widely accepted surgical approach for the resection of ICLM is either 1-stage approach or 2-stage approach. [12] In our study, more patients underwent 1-stage operation, indicating that it may be more beneficial to the patients because they experienced shorter operation time, anesthesia time and managed to recover faster with shorter hospital LOS. Although 1-stage operation resulted in more blood loss, the allogenic transfusion rates and postoperative complication rates did not differ between the 2 groups.…”

Section: Discussionmentioning

confidence: 80%

Perioperative management of intracardiac leiomyomatosis

Xu¹,

Wei²,

Miao

et al. 2017

Medicine

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Intracardiac leiomyomatosis (ICLM) is a rare condition in which the benign tumor extends into the right heart chambers through inferior vena cava. The best surgical approach still remains unclear.We present a retrospective cohort of 36 patients diagnosed with ICLM in Peking Union Medical College Hospital between 2002 and 2016.The mean patient age was 44.5 (range 25–55) years. The clinical manifestations were various, including shortness of breath, chest tightness, edema of the lower extremities, palpitations, syncope, etc. Cardiac function of 30 patients (80%) remained mildly influenced, classified as New York Heart Association (NYHA) I-II. After careful preoperative evaluation, 19 patients underwent 1-stage operation while the other 17 patients underwent 2-stage operations. The original surgical plans were changed in 5 patients (14%) due to intraoperative transesophageal echocardiography (TEE) monitoring, with the tumor directly extracted through abdominal approach or right atrium without cardiopulmonary bypass and/or deep hypothermic circulatory arrest. Complete resection was achieved in 32 patients (89%). Despite increased volume of blood loss (P < .05), patients undergoing 1-stage operation had significantly shorter operation time, anesthesia time as well as hospital length of stay (P < .05), compared with 2-stage operations. The postoperative complication rates were not different between the 2 groups (P = .684). During mean follow-up time of 36.1 months, recurrence occurred in 7 patients (23%) but all are survived.Precise and full-scale preoperative evaluation of both the tumor anatomy and the patient's tolerability to the surgery should be performed. TEE plays a crucial role in guidance of surgical decision making, and 1-stage extraction of tumor through either abdominal approach or right atrium may be possible.

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Section: Discussionmentioning

confidence: 80%

Perioperative management of intracardiac leiomyomatosis

Xu¹,

Wei²,

Miao

et al. 2017

Medicine

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“…However, anti‐estrogen therapy does not significantly improve the prognosis for IVL . The recurrence rate of IVL is reported to be about 27.8–31% . Additional surgery equates to further morbidity for patients, and in exceptional cases it is not always technically feasible completely to resect recurrent lesions, such as pelvic lesions involving the pelvic venous plexus.…”

Section: Discussionmentioning

confidence: 99%

“…4 The recurrence rate of IVL is reported to be about 27.8-31%. 4,5 Additional surgery equates to further morbidity for patients, and in exceptional cases it is not always technically feasible completely to resect recurrent lesions, such as pelvic lesions involving the pelvic venous plexus. Thus, it is important to find conservative treatments for patients to help control disease progress.…”

Section: Discussionmentioning

confidence: 99%

Rapamycin (sirolimus) in treatment of recurrent intravenous leiomyomatosis: a case report

Zhang

Feng

Wang

et al. 2020

BJOG

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“…In spite of this, no thromboembolic events occurred. In the review of the literature, the venous approach in order to remove the mass is usually performed by venotomy of the IVC directly [6,9,10]. By this approach, in stage II patients, a median of 1000cc blood loose has been reported [6].…”

Section: Discussionmentioning

confidence: 99%