Effects of Morcellation on Long-Term Outcomes in Patients with Uterine Leiomyosarcoma

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Abstract

Abstract Objectives 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. Materials The clinical cancer registry Regensburg (Germany) registered 64 patients between 2004 and 2013 with ULMS. A ...

Abstract

Abstract
Objectives 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.
Materials 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).
Results 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. nonmorcellation
(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).
Conclusion 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.