Robotic-Assisted Cytoreductive Surgery and Hyperthermic Intrathoracic Chemotherapy in Metastatic Pleuropulmonary Leiomyosarcoma - A Case Report

Sep 28, 2026

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Robotic-assisted cytoreductive surgery combined with hyperthermic intrathoracic chemotherapy (HITHOC) was used to treat metastatic pleuropulmonary leiomyosarcoma (LMS) in a 61-year-old male with progressive pleural and pulmonary metastases after prior systemic chemotherapy and palliative radiotherapy. PET-CT showed intense right hemithorax hypermetabolic activity. A multistep robotic thoracic approach performed total pleurectomy, pulmonary segmentectomy, and mediastinal lymphadenectomy with cisplatin at 42°C, achieving uncomplicated recovery and complete symptomatic relief. At 6 months, isolated local recurrence was managed by pazopanib, maintaining radiological stability and symptom control through 12 months.

LanguageEnglish

CategoryHealthcare

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Pages4

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Introduction

Case Presentation

Wiley Case Reports in Oncological Medicine Volume 2026, Article ID 4409000, 4 pages [https://doi.org/10.1155/crom/4409000](https://doi.org/10.1155/crom/4409000) Case Report Robotic-Assisted Cytoreductive Surgery and Hyperthermic Intrathoracic Chemotherapy in Metastatic Pleuropulmonary Leiomyosarcoma: A Case Report Mariana Canevari de Oliveira , 1 Paula Duarte D’Ambrosio ,2 David Pinheiro Cunha,3 Rodrigo Carvalho Marotta,4 Marcelo Manzano Said, 1 and Ricardo Mingarini Terra2 1Division of Thoracic Surgery in Hospital da PUC-Campinas, Campinas, State of São Paulo, Brazil 2 University of São Paulo, São Paulo, State of Sao Paulo, Brazil 3Grupo SOnHe, Campinas, State of Sao Paulo, Brazil 4Instituto do Radium de Campinas, Campinas, State of Sao Paulo, Brazil Correspondence should be addressed to Mariana Canevari de Oliveira; [mariana.canevari@gmail.com](mariana.canevari@gmail.com) Received 6 April 2025; Revised 16 October 2025; Accepted 12 November 2025 Academic Editor: Harleen Khatra Copyright © 2026 Mariana Canevari de Oliveira et al. Case Reports in Oncological Medicine published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. Leiomyosarcoma (LMS) is a rare and aggressive soft tissue sarcoma known for its propensity for hematogenous dissemination, frequently involving the lungs and pleura. We present a case of metastatic pleuropulmonary LMS managed with a novel combined approach: robotic-assisted cytoreductive surgery and hyperthermic intrathoracic chemotherapy (HITHOC) . A 61-year-old male with high-grade LMS developed progressive pleural and pulmonary metastases following prior systemic chemotherapy and palliative radiotherapy. Diagnostic imaging showed enlarging pleural nodules and diaphragmatic thickening, with PET-CT conﬁrming intense hypermetabolic activity conﬁned to the right hemithorax. A multistep robotic-assisted thoracic procedure was performed, including total pleurectomy, pulmonary segmentectomy, mediastinal lymphadenectomy, and HITHOC utilizing cisplatin at 42°C. The patient achieved an uncomplicated postoperative course and reported complete symptomatic relief of pre-existing pleuritic pain. At 6-months postprocedure, follow-up imaging conﬁrmed isolated local recurrence (two subpleural nodules) . However, no regional lymphadenopathy or distant progression was detected. The patient was transitioned to pazopanib therapy, which resulted in radiological stability and maintained symptomatic control through the 12-month postoperative follow-up period. This case demonstrates the feasibility, safety, and therapeutic value of robotic cytoreduction with HITHOC in selected metastatic LMS, achieving complete macroscopic resection and sustained 12-month disease control when integrated with targeted therapy. Keywords: HITHOC; hyperthermic intrathoracic chemotherapy; leiomyosarcoma; pleural metastases; robotic surgery; thoracic oncology 1. Introduction Leiomyosarcoma (LMS) is a malignant tumor of mesenchymal origin with high metastatic potential, frequently disseminating to the lungs and pleura. Although systemic chemotherapy remains the mainstay for advanced LMS, durable disease control is rarely achieved [1] . In selected patients with oligometastatic or localized progressive dis- ease, aggressive local treatment can provide meaningful symptom relief and improved locoregional control [2] . Robotic-assisted thoracic surgery (RATS) has markedly advanced the execution of complex thoracic oncology procedures. Its enhanced dexterity and three-dimensional visualization enable precise cytoreduction in anatomically challenging pleural regions. These technical advantages translate into reduced postoperative pain and faster 2 Case Reports in Oncological Medicine Figure 1: Preoperative PET-CT demonstrated increased 18F-F

FAQs

What procedure combination was used in the reported metastatic pleuropulmonary LMS case?

The patient was treated with robotic-assisted cytoreductive surgery combined with hyperthermic intrathoracic chemotherapy (HITHOC). The HITHOC used cisplatin at 42°C.

What diagnostic imaging findings supported the treatment decision?

PET-CT demonstrated intense hypermetabolic activity confined to the right hemithorax, including pleuropulmonary and diaphragmatic lesions, consistent with metabolically active metastatic disease.

How did the patient’s disease course progress after surgery and subsequent therapy?

Postoperatively, the patient had an uncomplicated recovery with complete symptomatic relief. Follow-up at 6 months showed isolated local recurrence, and pazopanib led to radiological stability and maintained symptom control through 12-month follow-up.

Sep 28, 2026

Uploaded by Stanford