Liver resection (bisegmentectomy II + III) in metastatic leiomyosarcoma of the cecum: clinical observation

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Abstract

Background. Leiomyosarcoma of the colon is a rare tumor of the gastrointestinal tract, the main treatment for which is radical surgical removal. Leiomyosarcomas are characterized by high malignant potential and a tendency to metastasize through the bloodstream to the lungs and liver. Surgical removal of metastatic foci in this group of patients is the only treatment option that can increase long-term survival.

Case report. The article presents a clinical case of surgical treatment of a 45-year-old female patient with metachronous metastasis of cecal leiomyosarcoma to the left lobe of the liver. The patient had previously undergone right-sided hemicolectomy, with a medical history of 19 months. During the next follow-up examination, a metastasis in the left lateral section of the liver was found. The multidisciplinary oncology team decided to perform liver resection followed by chemotherapy as the first step. The patient underwent left-sided bisegmentectomy (II + III) using the Arantius-first approach. The postoperative period was smooth. The patient is receiving drug antitumor therapy.

Conclusion. The treatment of patients with distant metastases of leiomyosarcoma is a complex oncological task requiring the participation of a multidisciplinary team of specialists. Combined treatment of metachronous metastatic disease in leiomyosarcoma can increase long-term survival and improve the patient’s quality of life.

About the authors

Andrey A. Muratov

Irkutsk State Medical Academy of Postgraduate Education – Branch of the Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia; Irkutsk Regional Cancer Center

Author for correspondence.
Email: murat.irk@mail.ru
ORCID iD: 0000-0003-3418-5034
Russian Federation, 100 mikrorayon Yubileyny, Irkutsk, 664049; 32 Frunze St., Irkutsk, 664035

R. I. Rasulov

Irkutsk State Medical Academy of Postgraduate Education – Branch of the Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia; Irkutsk Regional Cancer Center

Email: murat.irk@mail.ru
ORCID iD: 0000-0002-3671-1459
Russian Federation, 100 mikrorayon Yubileyny, Irkutsk, 664049; 32 Frunze St., Irkutsk, 664035

A. P. Ponomarenko

Irkutsk Regional Cancer Center

Email: murat.irk@mail.ru
ORCID iD: 0000-0003-2933-1981
Russian Federation, 32 Frunze St., Irkutsk, 664035

A. M. Bulytov

Irkutsk Regional Cancer Center

Email: murat.irk@mail.ru
ORCID iD: 0009-0001-9923-1751
Russian Federation, 32 Frunze St., Irkutsk, 664035

D. O. Malykh

Irkutsk Regional Cancer Center

Email: murat.irk@mail.ru
ORCID iD: 0009-0009-6382-1969
Russian Federation, 32 Frunze St., Irkutsk, 664035

B. D. Tsydenzhapov

Irkutsk Regional Cancer Center

Email: murat.irk@mail.ru
ORCID iD: 0009-0008-4009-8088
Russian Federation, 32 Frunze St., Irkutsk, 664035

References

  1. Øines M.N., Smith H.G., Preisler L. et al. Leiomyosarcoma of the abdomen and retroperitoneum; a systematic review. Front Surg 2024;11:1375483. doi: 10.3389/fsurg.2024.1375483
  2. Yasinzai A.Q.K., Lee K.T., Khan I. et al. Colorectal leiomyosarcoma: demographics patterns, treatment characteristics, and survival analysis in the U.S. population. J Gastrointest Cancer 2024;55(4):1588–97. doi: 10.1007/s12029-024-01110-x
  3. Rasulov R.I., Muratov A.A., Kuvshinov A.G. et al. Surgical treatment of leiomyosarcomas of the inferior vena cava and its tributaries. Vestnik khirurgii im. I.I. Grekova = I.I. Grekov Bulletin of Surgery 2022;181(4):52–60. (In Russ.). doi: 10.24884/0042-4625-2022-181-4-52-60
  4. Miettinen M., Furlong M., Sarlomo-Rikala M. et al. Gastrointestinal stromal tumors, intramural leiomyomas, and leiomyosarcomas in the rectum and anus: a clinicopathologic, immunohistochemical, and molecular genetic study of 144 cases. Am J Surg Pathol 2001;25(9):1121–33. doi: 10.1097/00000478-200109000-00002
  5. Alpert L., Al-Sabti R., Graham R.P. et al. Smooth muscle tumors of the gastrointestinal tract: an analysis of prognostic features in 407 cases. Mod Pathol 2020;33(7):1410–9. doi: 10.1038/s41379-020-0492-5
  6. Jaques D.P., Coit D.G., Casper E.S. et al. Hepatic metastases from soft-tissue sarcoma. Ann Surg 1995;221(4):392–7. doi: 10.1097/00000658-199504000-00010
  7. Kim Y.W., Lee J.H., Kim J.E. et al. Surgical resection of liver metastasis of leiomyosarcoma. Korean J Clin Oncol 2017;13(2):143–6. doi: 10.14216/kjco.17022
  8. Yahagi M., Ishii Y., Hara A. et al. Laparoscopic surgery to treat leiomyosarcomas of the sigmoid colon: a case report and literature review. Surg Case Rep 2019;5(1):20. doi: 10.1186/s40792-019-0579-8
  9. Grimme F.A.B., Seesing M.F.J., van Hillegersberg R. et al. On behalf of the Dutch Liver Surgery Working Group. Liver resection for hepatic metastases from soft tissue sarcoma: a nationwide study. Dig Surg 2019;36(6):479–86. doi: 10.1159/000493389
  10. Massaras D., Kontis E., Stamatis K. et al. Primary leiomyosarcoma of the colon with synchronous liver metastasis. Rare Tumors 2022;14:20363613221080549. doi: 10.1177/20363613221080549
  11. Kasagi Y., Sugiyama M., Yokomizo R. et al. Case of colon leiomyosarcoma arising from the muscularis mucosae: a case report and literature review. Surg Case Rep 2025;11(1):25-0146. doi: 10.70352/scrj.cr.25-0146
  12. Faraj W., El-Kehdy J., Nounou G.E. et al. Liver resection for metastatic colorectal leiomyosarcoma: a single center experience. J Gastrointest Oncol 2015;6(5):E70–6. doi: 10.3978/j.issn.2078-6891.2015.044
  13. Michels N.A. Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg 1966;112(3):337–47. doi: 10.1016/0002-9610(66)90201-7
  14. Ohkubo M., Nagino M., Kamiya J. et al. Surgical anatomy of the bile ducts at the hepatic hilum as applied to living donor liver transplantation. Ann Surg 2004;239(1):82–6. doi: 10.1097/01.sla.0000102934.93029.89
  15. Chen H., Pruitt A., Nicol T.L. et al. Complete hepatic resection of metastases from leiomyosarcoma prolongs survival. J Gastrointest Surg 1998;2(2):151–5. doi: 10.1016/s1091-255x(98)80006-1
  16. Wong G.S., Yudina S.V., Reyes M.C.D. Laparoscopic right hemicolectomy to curatively treat primary leiomyosarcoma at the ileocecal valve. ACG Case Rep J 2021;8(9):e00670. doi: 10.14309/crj.0000000000000670
  17. Lee S.H., Bae S.H., Lee S.C. et al. Curative resection of leiomyosarcoma of the descending colon with metachronous liver metastasis: a case report. World J Gastrointest Surg 2023;15(5):992–9. doi: 10.4240/wjgs.v15.i5.992
  18. Delisle M., Alshamsan B., Nagaratnam K. et al. Metastasectomy in leiomyosarcoma: a systematic review and pooled survival analysis. Cancers (Basel) 2022;14(13):3055. doi: 10.3390/cancers14133055
  19. Krzyston H., Morse B., Deperalta D. et al. Liver-directed treatments of liver-dominant metastatic leiomyosarcoma. Diagn Interv Radiol 2020;26(5):449–55. doi: 10.5152/dir.2020.19405
  20. Ome Y., Honda G., Kawamoto Y. Laparoscopic left hemihepatectomy by the Arantius-first approach: a video case report. J Gastrointest Surg 2020;24(9):2180–2. doi: 10.1007/s11605-020-04683-7
  21. Wang J., Xu J., Lei K. et al. Laparoscopic left hemihepatectomy guided by real-time indocyanine green fluorescence imaging using the Arantius-first approach. World J Surg Onc 2023;21:282. doi: 10.1186/s12957-023-03165-9
  22. Tranchart H., Gaillard M., Lainas P. et al. Selective control of the left hepatic vein during laparoscopic liver resection: Arentius’ ligament approach. J Am Coll Surg 2015;221(4):e75–9. doi: 10.1016/j.jamcollsurg.2015.07.009
  23. Majno P.E., Mentha G., Morel P. et al. Arantius’ ligament approach to the left hepatic vein and to the common trunk. J Am Coll Surg 2002;195(5):737–9. doi: 10.1016/s1072-7515(02)01324-8
  24. Morjane A., Dahmane R., Ravnik D. et al. Anatomy and surgical relevance of the hepatocaval ligament. A study on cadaveric livers. Cells Tissues Organs 2008;187(3):243–6. doi: 10.1159/000110083

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