Francesco Raspagliesi1, Giuseppa Maltese1, Giorgio Bogani1, Giovanni Fucà2, Stefano Lepori1, Pierandrea De Iaco3, Myriam Perrone3, Giovanni Scambia4, Gennaro Cormio5, Stefano Bogliolo6, Alice Bergamini7, Giuseppe Bifulco8, Paolo Giovanni Casali2, Domenica Lorusso9. 1. Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Gynecologic Oncology, Milan, Italy. 2. Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Medical Oncology, Milan, Italy. 3. University of Bologna, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, S. Orsola Hospital, Bologna, Italy. 4. Catholic University of The Sacred Heart, Division of Gynecologic Oncology, Rome, Italy. 5. Oncology Institute "Giovanni Paolo II", Bari, Italy; University of Bari, Gynecologic Oncology Unit, Bari, Italy. 6. IRCCS Fondazione Policlinico San Matteo, University of Pavia, Department of Obstetrics and Gynecology, Pavia, Italy. 7. San Raffaele Hospital, Department of Obstetrics and Gynecology, Milan, Italy. 8. University of Naples "Federico II", Department of Neuroscience and Reproductive and Odontostomatologic Science, Naples, Italy. 9. Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Gynecologic Oncology, Milan, Italy. Electronic address: domenica.lorusso@istitutotumori.mi.it.
Abstract
OBJECTIVE: To investigate the impact of morcellation on survival outcomes of patients affected by undiagnosed uterine sarcoma. METHODS: This is a retrospective study performed in 8 referral centers of MITO group. Data of women undergoing morcellation for apparent benign uterine myomas who were ultimately diagnosed with stage I uterine sarcoma on final pathology were compared with data of women who did not undergo morcellation. Uterine sarcoma included: leiomyosarcomas (LMS), smooth muscle tumors of uncertain malignant potential (STUMP), low-grade endometrial stromal sarcomas (LG-ESS) and undifferentiated uterine sarcomas (UUS). Two-year survival outcomes were evaluated using Kaplan-Meir and Cox models. RESULTS: Overall 125 patients were identified: 31(24.8%), 21(16.8%) and 73(58.4%) patients had power morcellation during laparoscopy, non power morcellation during open surgery and non morcellation during open procedures, respectively. Considering patients affected by LMS, morcellation did not correlated with disease-free survival. However, patients undergoing either morcellation or power morcellation experienced a 3-fold increase risk of death in comparison to patients who had not morcellation (p=0.02). A trend towards an increase of recurrence was observed for patients undergoing morcellation for STUMP (HR 7.7, p=0.09); while no differences in survival outcomes were observed for patients with LG-ESS and UUS. CONCLUSIONS: Our data suggest that morcellation increase the risk of death in patients affected by undiagnosed LMS. Further prospective studies are warranted in order to assess the risk to benefit ratio of power morcellator utilization in patients with apparent benign uterine myomas.
OBJECTIVE: To investigate the impact of morcellation on survival outcomes of patients affected by undiagnosed uterine sarcoma. METHODS: This is a retrospective study performed in 8 referral centers of MITO group. Data of women undergoing morcellation for apparent benign uterine myomas who were ultimately diagnosed with stage I uterine sarcoma on final pathology were compared with data of women who did not undergo morcellation. Uterine sarcoma included: leiomyosarcomas (LMS), smooth muscle tumors of uncertain malignant potential (STUMP), low-grade endometrial stromal sarcomas (LG-ESS) and undifferentiated uterine sarcomas (UUS). Two-year survival outcomes were evaluated using Kaplan-Meir and Cox models. RESULTS: Overall 125 patients were identified: 31(24.8%), 21(16.8%) and 73(58.4%) patients had power morcellation during laparoscopy, non power morcellation during open surgery and non morcellation during open procedures, respectively. Considering patients affected by LMS, morcellation did not correlated with disease-free survival. However, patients undergoing either morcellation or power morcellation experienced a 3-fold increase risk of death in comparison to patients who had not morcellation (p=0.02). A trend towards an increase of recurrence was observed for patients undergoing morcellation for STUMP (HR 7.7, p=0.09); while no differences in survival outcomes were observed for patients with LG-ESS and UUS. CONCLUSIONS: Our data suggest that morcellation increase the risk of death in patients affected by undiagnosed LMS. Further prospective studies are warranted in order to assess the risk to benefit ratio of power morcellator utilization in patients with apparent benign uterine myomas.
Authors: Xiao Xu; Haiqun Lin; Jason D Wright; Cary P Gross; Francis P Boscoe; Lindsey M Hutchison; Peter E Schwartz; Vrunda B Desai Journal: J Clin Oncol Date: 2019-09-16 Impact factor: 44.544
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Authors: Dominik Denschlag; Sven Ackermann; Marco Johannes Battista; Wolfgang Cremer; Gerlinde Egerer; Markus Follmann; Heidemarie Haas; Philipp Harter; Simone Hettmer; Lars-Christian Horn; Ingolf Juhasz-Boess; Karin Kast; Günter Köhler; Thomas Kröncke; Katja Lindel; Peter Mallmann; Regine Meyer-Steinacker; Alexander Mustea; Edgar Petru; Peter Reichardt; Dietmar Schmidt; Hans-Georg Strauss; Clemens Tempfer; Falk Thiel; Uwe Ulrich; Thomas Vogl; Dirk Vordermark; Paul Gass; Matthias W Beckmann Journal: Geburtshilfe Frauenheilkd Date: 2019-10-22 Impact factor: 2.915
Authors: Matthew L Hemming; Kelly S Klega; Justin Rhoades; Gavin Ha; Kate E Acker; Jessica L Andersen; Edwin Thai; Anwesha Nag; Aaron R Thorner; Chandrajit P Raut; Suzanne George; Brian D Crompton Journal: JCO Precis Oncol Date: 2019-01-24
Authors: Rosanne M Kho; Vrunda B Desai; Peter E Schwartz; Jason D Wright; Cary P Gross; Lindsey M Hutchison; Francis P Boscoe; Haiqun Lin; Xiao Xu Journal: J Minim Invasive Gynecol Date: 2021-07-13 Impact factor: 4.137