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

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.