Abstract
Uterine leiomyosarcoma is a rare female reproductive system tumor which is difficult to distinguish from uterine leiomyoma preoperatively. Manual and power morcellation are used to remove the large uterus through the vagina or small abdominal incision. Worse outcome with use of power morcellation is now clear but impact of manual morcellation on survival outcome not established till date. The objective of the present study was to find impact of tumor spillage and to evaluate influencing factors for oncological outcome and prognosis in uterine leiomyosarcoma patients. This is a single-institutional retrospective cohort study including all uterine leiomyosarcoma patients from January 2005 to December 2017. Role of intraoperative tumor spillage and other influencing factors on oncological outcome were assessed. Thirty-three patients with median follow-up period of 49.7 months were evaluated. Stage 1 and absence of tumor spill had significant association with prolonged progression-free survival. Stage 1 uterine leiomyosarcoma (56.8 vs 6.8 months, p = < 0.001), intraoperative tumor spillage (p = 0.03) and progression-free survival > 15 months (68.5 vs 12.2 months, p = < 0.001) were favourable prognostic factors to predict better survival outcome but unable to establish significance on multivariate analysis. Survival plot did not reach median limit for stage I uterine leiomyosarcoma patients with preoperative suspicion. Age, site of recurrence and mitotic index had no significant association with better survival in the present study. Stage I disease and absence of tumor spillage during surgery improved progression-free survival but did not affect overall survival. Progression-free survival more than 15 months can predict better overall survival.
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Dr. Viral Patel (DNB): conception and design of study, data collection, data analysis and interpretation, manuscript preparation, final approval.
Dr. Anupama R Rajanbabu (MD, MRCOG): conception and design of study, data analysis and interpretation, final approval of the version to be published.
Dr. Indu R Nair (MD): data analysis and interpretation, responsible imager, manuscript preparation, final approval.
Dr. Pramod R Pillai (MCh): conception and design of study, data collection, manuscript preparation, final approval.
Greeshma C Ravindran (MSc): statistical analysis, manuscript preparation, final approval.
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Received on 11/02/2020 (IRB-AIMS-2020–026).
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Patel, V., Rajanbabu, A., Nair, I.R. et al. Impact of Intraoperative Tumor Spillage in Uterine Leiomyosarcoma: a Retrospective Single-Institution Analysis. Indian J Surg Oncol 12, 581–586 (2021). https://doi.org/10.1007/s13193-021-01406-5
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DOI: https://doi.org/10.1007/s13193-021-01406-5