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Effects of morcellation on long-term outcomes in patients with uterine leiomyosarcoma

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objectives

Clinical long-term outcomes of women with uterine leiomyosarcoma (ULMS) with different types of hysterectomy (open abdominal, vaginal, laparoscopic and switch from laparoscopic to open abdominal) were compared according to morcellation and other factors.

Materials

The clinical cancer registry Regensburg (Germany) registered 64 patients between 2004 and 2013 with ULMS. A retrospective cohort analysis was performed using the Kaplan–Meier method to estimate 5-year overall survival (OAS), recurrence-free survival (RFS) and recurrence rates. To compare surgery with or without morcellation log rank test was used. To adjust for age, FIGO stage, grading and other factors multivariable Cox regression models were applied to estimate hazard ratios (HR).

Results

In the cohort of 64 patients 15 underwent morcellation, preferably during laparoscopic surgery. Although numbers were small we performed analysis for OAS and RFS. Median OAS for morcellation was 10.6 vs. 6.4 years for non morcellation. 5y-OAS was 76.0 % for morcellation compared to 54.8 % in patients without morcellation (p = 0.115). Cox regression models rendered an unadjusted (univariable) HR 0.428 for morcellation vs. non-morcellation (p = 0.125) and an adjusted (multivariable) HR 0.644 (p = 0.406). 5y-RFR was 64.0 % compared to 42.8 % in patients without morcellation (p = 0.104; unadjusted HR 0.484, p = 0.111; adjusted HR 0.607, p = 0.306).

Conclusion

In general, the prognosis of patients with ULMS is poor. In our cohort, women who underwent hysterectomy with morcellation had a better cumulative OAS and RFS than women without morcellation. Although we adjusted for differences between women with and without morcellation regarding age, grading and stage, there were no statistically significant differences between the groups.

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    Authors and Affiliations

    1. Department of Gynecology and Obstetrics, University Medical Center Regensburg, Landshuter Straße 65, 93053, Regensburg, Germany

      W. Nemec, E. C. Inwald, S. Buchholz & O. Ortmann

    2. Tumor Center Regensburg e.V., University Regensburg, Regensburg, Germany

      M. Klinkhammer Schalke & M. Gerken

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    1. W. Nemec
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    2. E. C. Inwald
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    3. S. Buchholz
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    4. M. Klinkhammer Schalke
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    5. M. Gerken
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    6. O. Ortmann
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    Correspondence to O. Ortmann.

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    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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    The authors declare that they have no conflict of interest.

    Human and animal rights statement

    This article is a retrospective study and does not contain any studies with human participants or animals performed of any of the authors.

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    W. Nemec and E.C. Inwald contributed equally to this paper.

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    Nemec, W., Inwald, E.C., Buchholz, S. et al. Effects of morcellation on long-term outcomes in patients with uterine leiomyosarcoma. Arch Gynecol Obstet 294, 825–831 (2016). https://doi.org/10.1007/s00404-016-4086-x

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    • DOI: https://doi.org/10.1007/s00404-016-4086-x

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