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

OBJECTIVE: In the last 5 years there has been a lot of discussion about the surgical procedure for uterine fibroids and essentially also uterine sarcoma. Still there exist no reliable presurgical diagnostic tool to differentiate between benign fibroids and uterine sarcomas. The aim of this study was to confirm the suspected an association between intraoperative spread of tumor by morcellation and impaired outcome in sarcoma patients.

MATERIAL AND METHODS: After local ethics commission positively reviewed the study protocol the oncological database of our university hospital was retrospectively reviewed for patients with uterine sarcomas over a time period of 13 years (2002-2015). Data was extracted from the medical files and survival information was collected by contacting patient´s general practitioners if last follow-up-status was older than 6 months. For the analysis patients were split into two groups with either intrasurgical morcellation (M+) or no morcellation (M-) regarding information provided by the surgical report.

RESULTS: Data on 57 uterine sarcoma patients was available for further analysis. The median age was 63years with a BMI of 27 kg/m². The sarcoma subtypes were 25 leiomyosarcoma (LMS), 19 carcinosarcoma (KS), 9 endometriod stroma sarcoma (ESS), 3 adenosarcoma (AS) and one case without further differentiation. In the majority, no morcellation was done (44 patients in M- group) and 51 patients received open surgery (3 laparoscopic, 1 vaginal and 2 incomplete surgeries). Median time of follow-up was 31 months. The disease free survival was 50.5 months and the cox regressions analysis showed a hazard ratio of 3.06 (no significant difference between the two subgroups (p=0.079; 95%-KI: 0.9 - 10.6)). The overall survival was found to be 62.2 months and the cox regression analysis showed a hazard ratio of 3.216 with statistical significantdifference between the two subgroups (p=0.013; 95%-KI: 1.3 - 8.1).

CONCLUSION: Despite the efforts to find a pre-surgical diagnostic tool, the clinical situation remains unsatisfactory. Overall sarcoma prevalence is low during the last 13 years at our university center, but morcellation occurred in a relevant portion of patients (13 out of 57). If a sarcoma is suspected or diagnosed the en-bloc resection of the uterus can prolong the survival. Thus, morcellation of the uterus and not the surgical technique (en-bloc resection) is the prognostic factor and should be avoided in any suspicious case.