Effects of morcellation on long-term outcomes in patients with uterine leiomyosarcoma
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.
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).
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).
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.
KeywordsUterine leiomyosarcoma Surgery Morcellation Survival
Compliance with ethical standards
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.
Conflict of interest
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.
- 9.Inwald EC, Koller M, Klinkhammer-Schalke M, Zeman F, Hofstädter F, Lindberg P, Gerstenhauer M, Schüler S, Treeck O, Ortmann O (2015) Adjuvant endocrine therapy in pre- vs. postmenopausal patients with steroid hormone receptor-positive breast cancer: results from a large population-based cohort of a cancer registry. J Cancer Res Clin Oncol 141:2229–2240CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Kamikubeya TS, Etchebehere RM, Nomelini RS et al (2010) Gynecological malignant neoplasias diagnosed after hysterectomy performed for leiomyoma in a university hospital. Eur J Gynaecol Oncol 31(6):651–653Google Scholar
- 17.Ebner F, Friedl TW, Scholz C, Schochter F, Janni W, Vorwerk E, deGregorio N (2015) Is open surgery the solution to avoid morcellation of uterine sarcomas? A systematic literature review on the effect of tumor morcellation and surgical techniques. Arch Gynecol Obstet 292(3):499–506CrossRefPubMedGoogle Scholar
- 20.Parker WH, Fu YS, Berek JS (1994) Uterine sarcoma in patients operated on for presumed leiomyoma and rapidly growing leiomyoma. Obstet Gynecol 383:414–418Google Scholar