Effect of tumor morcellation in patients with early uterine sarcoma: a multicenter study in Germany
- 31 May 2022
- journal article
- research article
- Published by Galenos Yayinevi in Journal of the Turkish-German Gynecological Association
- Vol. 23 (2), 75-82
- https://doi.org/10.4274/jtgga.galenos.2022.2021.9-17
Abstract
Objective: The use of power morcellation at laparoscopy may worsen survival rates for patients with malignancy. The aim of the present study was to report the outcome of patients with early-stage uterine sarcoma after morcellation or total en-bloc resection, and evaluate potential signs of sarcoma preoperatively. Material and Methods: This multicenter retrospective study consisted of patients, who underwent surgery for FIGO-stage-1 uterine sarcoma. Twenty-four patients were divided into a non-morcellation group and a morcellation group. Clinical records and the outcomes of patients, including one-, three-and five-year survival rates were reviewed. Preoperative characteristics of patients with sarcoma were compared to those of a control group with uterine myoma (1:4 ratio), matched by age and type of operation. Results: Obesity was an independent risk factor for uterine myoma. Tumor growth, solitary growth, largest-diameter lesion >8.0 cm, and anechoic areas suggesting necrosis and increased vascularization were significantly more common in the sarcoma group. A large tumor diameter was significantly associated with mortality. Patients in the non-morcellation group had a slightly lower disease-free survival, but poorer overall survival (OS) rates compared to patients in the morcellation group, but neither difference was statistically significant. Patients in the nonmorcellation group, who had undergone a re-exploration experienced late recurrence, but no upstaging was evident after the operation. Conclusion: Preoperative ultrasound characteristics could be useful to distinguish sarcoma from leiomyoma of uterus. Morcellation of a sarcoma may increase abdominal and pelvic recurrence rates, but may not be associated with OS in patients with FIGO-stage-1 disease.Keywords
This publication has 34 references indexed in Scilit:
- Obesity as a Major Risk Factor for CancerJournal of Obesity, 2013
- Incidence of uterine leiomyosarcoma and endometrial stromal sarcoma in Nordic countries: Results from NORDCAN and NOCCA databasesMaturitas, 2012
- Clinical presentation and diagnosis of uterine sarcoma, including imagingBest Practice & Research Clinical Obstetrics & Gynaecology, 2011
- A nomogram to predict postresection 5‐year overall survival for patients with uterine leiomyosarcomaCancer, 2011
- Interdisciplinary S2k guidelines on the diagnosis and treatment of endometrial carcinomaZeitschrift für Krebsforschung und Klinische Onkologie, 2009
- Uterine Leiomyosarcoma: Does the Primary Surgical Procedure Matter?International Journal of Gynecologic Cancer, 2009
- Management of uterine malignancy found incidentally after supracervical hysterectomy or uterine morcellation for presumed benign diseaseInternational Journal of Gynecologic Cancer, 2008
- The utility of preoperative endometrial sampling for the detection of uterine sarcomasGynecologic Oncology, 2008
- The risk of developing uterine sarcoma after tamoxifen useInternational Journal of Gynecologic Cancer, 2008
- Can gray‐scale and color Doppler sonography differentiate between uterine leiomyosarcoma and leiomyoma?Journal of Clinical Ultrasound, 2007