Results of an internal audit on the survival of patients with uterine sarcoma

Abstract

Objective: In the last 5 years there has been much discussion about the surgical procedure for uterine fibroids, and essentially, also uterinesarcoma. Still there exists no reliable presurgical diagnostic tool to differentiate between benign fibroids and uterine sarcomas. The aim of thisstudy was to confirm the suspected association between intraoperative spread of tumor by morcellation and impaired outcomes in patients withsarcoma.Material and Methods: After the local ethics commission positively reviewed the study protocol, the oncologic database of our universityhospital was retrospectively reviewed for patients with uterine sarcomas over a time period of 13 years (2002-2015). Data was extracted fromthe medical files and survival information was collected by contacting the patient’s general practitioners if last follow-up-status was older than6 months. For the analysis, patients were split into two groups with either intrasurgical morcellation (M+) or no morcellation (M-) regardinginformation provided by the surgical report.Results: Data on 57 patients with uterine sarcoma were available for further analysis. The median age and body mass index of the patients was63 years and 27 kg/m², respectively. The sarcoma subtypes were 25 leiomyosarcoma, 19 carcinosarcoma, 9 endometrioid stroma sarcoma, 3adenosarcoma, and one case without further differentiation. In the majority, no morcellation was performed (M- group, n=44) and 51 patientsreceived open surgery (3 laparoscopic, 1 vaginal, and 2 incomplete surgeries). The median time of follow-up was 31 months. The disease-freesurvival was 50.5 months and the Cox regression analysis showed a hazard ratio of 3.06 [no significant difference between the two subgroups(p=0.079; 95% confidence interval (CI): 0.9-10.6)]. The overall survival was found as 62.2 months and the Cox regression analysis showed ahazard ratio of 3.216 with a statistically significant difference between the two subgroups (p=0.013; 95% CI: 1.3-8.1).Conclusion: Despite the efforts to find a pre-surgical diagnostic tool, the clinical situation remains unsatisfactory. Overall sarcoma prevalence islow during the last 13 years at our university center, but morcellation occurred in a relevant portion of patients (13 of 57). If sarcoma is suspectedor diagnosed then en-bloc resection of the uterus can prolong survival. Thus, morcellation of the uterus and not the surgical technique (en-blocresection) is the prognostic factor and should be avoided in any suspicious case. (J Turk Ger Gynecol Assoc 2019; 20: 15-22)