Clinical outcome affected by tumor morcellation in unexpected early uterine leiomyosarcoma
Journal
Taiwanese Journal of Obstetrics and Gynecology
Journal Volume
54
Journal Issue
2
Pages
172-177
Date Issued
2015
Author(s)
Abstract
Objective: To evaluate the influence of morcellation during surgery on clinical outcome in unexpected early uterine leiomyosarcomas (LMSs) using a tumor-size-matched comparison study. Materials and methods: We retrospectively reviewed the clinicopathological characteristics, prognostic factors, and treatment outcomes of patients with Stage 1 uterine LMS from April 1993 to April 2014 in a university-based tertiary hospital. Patients who received morcellation via abdomen, vagina, or laparoscopy were compared with tumor-size-matched patients who underwent total hysterectomy without morcellation. Results: In total, 34 consecutive patients were identified, including 14 patients with morcellation and 20 patients without morcellation. There were no significant difference between the two groups of patients in age, parity, mitotic count, lymph node dissection, and adjuvant therapy. Six (42.9%) patients with morcellation were reoperated at 18.5 days after the initial surgery. Tumor recurrence rates at local and distant sites showed no difference between the two groups of patients. Patients with morcellation had a marginally lower disease-free survival (DFS) and overall survival (OS) rates compared with patients without morcellation. In univariate analysis, morcellation was marginally significantly associated with lower DFS [hazard ratio (HR), 2.62; 95% confidence interval, 0.89-7.71; p=0.08] and OS (HR, 2.70; 95% confidence interval, 0.89-8.20; p=0.08). In multivariate analysis, morcellation was associated with lower OS in marginal significance (HR, 2.94; 95% confidence interval, 0.83-10.39; p=0.09). Conclusion: Tumor morcellation did not increase the abdominal-pelvic recurrence rate, but may be associated with lower DFS and OS in Stage 1 LMS. ? 2015. Taiwan Association of Obstetrics & Gynecology. Published by Elsevier Taiwan LLC.
SDGs
Other Subjects
antineoplastic agent; adult; Article; cancer chemotherapy; cancer localization; cancer patient; cancer radiotherapy; cancer recurrence; cancer size; cancer staging; cancer surgery; cancer survival; clinical article; clinical feature; controlled study; disease free survival; early cancer; female; follow up; human; hysterectomy; lymph node dissection; medical record review; mitosis index; multimodality cancer therapy; myomectomy; outcome assessment; ovarian preservation; overall survival; parity; recurrence risk; reoperation; retrospective study; survival rate; survival time; tumor morcellation; uterus sarcoma; vaginal hysterectomy; aged; comparative study; evaluation study; hysterectomy; laparoscopy; leiomyosarcoma; middle aged; morcellation; mortality; multivariate analysis; procedures; survival; treatment outcome; tumor recurrence; Uterine Neoplasms; very elderly; Adult; Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Hysterectomy; Laparoscopy; Leiomyosarcoma; Middle Aged; Morcellation; Multivariate Analysis; Neoplasm Recurrence, Local; Reoperation; Retrospective Studies; Survival Analysis; Treatment Outcome; Uterine Neoplasms
Publisher
Elsevier Ltd
Type
journal article