Archives of Gynecology and Obstetrics

, Volume 294, Issue 4, pp 825–831 | Cite as

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

  • W. Nemec
  • E. C. Inwald
  • S. Buchholz
  • M. Klinkhammer Schalke
  • M. Gerken
  • O. Ortmann
Gynecologic Oncology



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.


Uterine leiomyosarcoma Surgery Morcellation Survival 


Compliance with ethical standards

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.


  1. 1.
    D’AngeIo E, Prat J (2010) Uterine sarcomas: a review. Gynecol Oncol 116:131–139CrossRefGoogle Scholar
  2. 2.
    Harlow BL, Weiss NS, Lofton S (1986) The epidemiology of sarcomas of the uterus. J Natl Cancer Inst 76(3):399–402PubMedGoogle Scholar
  3. 3.
    Nam JH, Park JY (2010) Update on treatment of uterine sarcoma. Curr Opin Obstet Gynecol 22(1):36–42CrossRefPubMedGoogle Scholar
  4. 4.
    Park JY, Kim DY, Suh DS, Kim JH, Kim YM, Kim YT et al (2008) Prognostic factors and treatment outcomes of patients with uterine sarcoma: analysis of 127 patients at a single institution, 1989–2007. J Cancer Res Clin Oncol 134:1277–1287CrossRefPubMedGoogle Scholar
  5. 5.
    Aviram R, Ochshorn Y, Markovitch O et al (2005) Uterine sarcomas vs. leiomyomas: gray-scale and Doppler sonographic findings. Clin Ultrasound 33(1):10–13CrossRefGoogle Scholar
  6. 6.
    Fukunishi H, Funaki K, Ikuma K, Kaji Y, Sugimura K, Kitazawa R, Kitazawa S (2007) Unsuspected uterine leiomyosarcoma: magnetic resonance imaging findings before and after focused ultrasound surgery. Int J Gynecol Cancer 17(3):724–728CrossRefPubMedGoogle Scholar
  7. 7.
    Chen SY, Chang DY, Sheu BC (2008) Laparoscopic-assisted vaginal hysterectomy with in situ morcellation for large uteri. J Minim Invasive Gynecol 15(5):559–565CrossRefPubMedGoogle Scholar
  8. 8.
    Anupama R, Ahmad SZ, Kuriakose S, Vijaykumar DK, Pavithran K, Seethalekshmy NV (2011) Disseminated peritoneal leiomyosarcomas after laparoscopic “myomectomy” and morcellation. J Minim Invasive Gynecol 18(3):386–389CrossRefPubMedGoogle Scholar
  9. 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. 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
  11. 11.
    Leibsohn S, d’AbIaing G, Mishell Jr DR et al (1990) Leiomyosarcoma in a series of hysterectomies performed for presumed uterine leiomyomas. Am J Obstet Gynecol 162:968–974 (discussion 974–976) CrossRefPubMedGoogle Scholar
  12. 12.
    Park JY, Park SK, Kim DY et al (2011) The impact of tumor morcellation during surgery on the prognosis of patients with apparently early uterine leiomyosarcoma. Gynecol Oncol 122:255–259CrossRefPubMedGoogle Scholar
  13. 13.
    Perri T, Korach J, Sadetzki S et al (2009) Uterine leiomyosarcomaz does the primary surgical procedure matter? Int J Gynecol Cancer 19:257–260CrossRefPubMedGoogle Scholar
  14. 14.
    Oduyebo T, Rauh-Hain AJ, Meserve EE et al (2014) The value of re-exploration in patients with inadvertently morcellated uterine sarcoma. Gynecol Oncol 132:360–365CrossRefPubMedGoogle Scholar
  15. 15.
    Morice P, Rodriguez A, Rey A et al (2003) Prognostic value of initial surgical procedure for patients with uterine sarcoma: analysis of 123 patients. Eur J Gynaecol Oncol 24:237–240PubMedGoogle Scholar
  16. 16.
    George S, Barysauskas C, Serrano C, Oduyebo T, Rauh-Hain JA et al (2014) Retrospective cohort study evaluating the impact of intraperitoneal morcellation on outcomes of localized uterine leiomyosarcoma. Cancer 120(20):3154–3158CrossRefPubMedGoogle Scholar
  17. 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
  18. 18.
    Zivanovic O, Jacks LM, Iasonos A, Leitao MM Jr et al (2012) A nomogram to predict postresection 5-year overall survival for patients with uterine leiomyosarcoma. Cancer 118(3):660–669CrossRefPubMedGoogle Scholar
  19. 19.
    Cantú de Léon D, González H, Pérez Montiel D et al (2013) Uterine sarcomas: review of 26 years at The lnstituto Nacional de Cancerologia of Mexico. Int J Surg 11:518–523CrossRefPubMedGoogle Scholar
  20. 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
  21. 21.
    Leung F, Terzibachian JJ (2012) Re: “The impact of tumor morcellation during surgery on the prognosis of patients with apparently early uterineleiomyosarcoma”. Gynecol Oncol 124:172–173 (author reply 173) CrossRefPubMedGoogle Scholar
  22. 22.
    Rivard C, Salhadar A, Kenton K (2012) New challenges in detecting, grading, and staging endometrial cancer after uterine morcellation. J Minim Invasive Gynecol 19(3):313–316CrossRefPubMedGoogle Scholar
  23. 23.
    Ehdaivand S, Simon RA, Sung CJ, Steinhoff MM, Lawrence WD, Quddus MR (2014) Incidental gynecologic neoplasms in morcellated uterine specimens: a case series with follow-up. Hum Pathol 45(11):2311–2317CrossRefPubMedGoogle Scholar
  24. 24.
    Einstein MH, Barakat RR, Chi DS et al (2008) Management of uterine malignancy found incidentally after supracervical hysterectomy or uterine morcellation for presumed benign disease. Int J Gynecol Cancer 18:1065–1070CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • W. Nemec
    • 1
  • E. C. Inwald
    • 1
  • S. Buchholz
    • 1
  • M. Klinkhammer Schalke
    • 2
  • M. Gerken
    • 2
  • O. Ortmann
    • 1
  1. 1.Department of Gynecology and ObstetricsUniversity Medical Center RegensburgRegensburgGermany
  2. 2.Tumor Center Regensburg e.V.University RegensburgRegensburgGermany

Personalised recommendations