Marta Wais1, Elissa Tepperman2, Marcus Q Bernardini3, Lilian T Gien4, Waldo Jimenez5, Ally Murji6. 1. Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON. 2. Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON. 3. Division of Gynaecologic Oncology, University Health Network, University of Toronto, Toronto, ON. 4. Division of Gynaecologic Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON. 5. Division of Gynecologic Oncology, Department of Obstetrics and Gynaecology, Juravinski Cancer Centre, McMaster University, Hamilton, ON. 6. Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON. Electronic address: ally.murji@sinaihealthsystem.ca.
Abstract
OBJECTIVE: Professional societies have recently urged gynaecologists to counsel patients about the risks of encountering uterine sarcoma at fibroid surgery especially when morcellation is used. Our objective was to learn the preoperative and postoperative characteristics of patients with uterine sarcoma to better counsel patients undergoing surgery for presumably benign fibroids. METHODS: This is a multicentre, retrospective cohort study. Three academic tertiary cancer centres in Southern Ontario over a 13-year period (2001-2014). Patients diagnosed with leiomyosarcoma or endometrial stromal sarcoma were included after identification using pathology databases. A retrospective chart review was conducted to determine clinical characteristics and survival data. RESULTS: The study included 302 patients with uterine sarcomas (221 leiomyosarcomas, 81 endometrial stromal sarcomas). Mean age at diagnosis was 55 years, and 59% were postmenopausal. Sarcoma diagnosis was made following endometrial sampling (25%), hysterectomy (69% laparotomy, 2.7% laparoscopic/vaginal), and myomectomy (3.3%). Of all the patients who underwent endometrial sampling, 65% were diagnosed with a uterine sarcoma in this manner. A general gynaecologist performed the primary surgical procedure in 166 of 302 patients (55%). Tumour disruption at the time of primary surgery occurred in 57 of 295 patients (19%): subtotal hysterectomy (21), myomectomy (10), dissection of adherent tumour (17), and morcellation (9). Morcellation, to facilitate a minimally invasive approach, was performed with scalpel (2 at laparotomy, 5 vaginally) and with a laparoscopic electro-mechanical morcellator (2). At a median follow-up of 2.9 years, there was no significant difference in survival for stage I and II patients with tumour disruption (n = 32) compared with those without tumour disruption (n = 143), regardless of sarcoma type (P = 0.6). CONCLUSION: The majority of patients with uterine sarcomas were postmenopausal. Many can be diagnosed preoperatively with endometrial sampling. Forty-one percent of patients with uterine sarcomas had a high preoperative index of suspicion, resulting in intervention by an oncologist. Morcellation with laparoscopic electro-mechanical morcellator was rare.
OBJECTIVE: Professional societies have recently urged gynaecologists to counsel patients about the risks of encountering uterine sarcoma at fibroid surgery especially when morcellation is used. Our objective was to learn the preoperative and postoperative characteristics of patients with uterine sarcoma to better counsel patients undergoing surgery for presumably benign fibroids. METHODS: This is a multicentre, retrospective cohort study. Three academic tertiary cancer centres in Southern Ontario over a 13-year period (2001-2014). Patients diagnosed with leiomyosarcoma or endometrial stromal sarcoma were included after identification using pathology databases. A retrospective chart review was conducted to determine clinical characteristics and survival data. RESULTS: The study included 302 patients with uterine sarcomas (221 leiomyosarcomas, 81 endometrial stromal sarcomas). Mean age at diagnosis was 55 years, and 59% were postmenopausal. Sarcoma diagnosis was made following endometrial sampling (25%), hysterectomy (69% laparotomy, 2.7% laparoscopic/vaginal), and myomectomy (3.3%). Of all the patients who underwent endometrial sampling, 65% were diagnosed with a uterine sarcoma in this manner. A general gynaecologist performed the primary surgical procedure in 166 of 302 patients (55%). Tumour disruption at the time of primary surgery occurred in 57 of 295 patients (19%): subtotal hysterectomy (21), myomectomy (10), dissection of adherent tumour (17), and morcellation (9). Morcellation, to facilitate a minimally invasive approach, was performed with scalpel (2 at laparotomy, 5 vaginally) and with a laparoscopic electro-mechanical morcellator (2). At a median follow-up of 2.9 years, there was no significant difference in survival for stage I and II patients with tumour disruption (n = 32) compared with those without tumour disruption (n = 143), regardless of sarcoma type (P = 0.6). CONCLUSION: The majority of patients with uterine sarcomas were postmenopausal. Many can be diagnosed preoperatively with endometrial sampling. Forty-one percent of patients with uterine sarcomas had a high preoperative index of suspicion, resulting in intervention by an oncologist. Morcellation with laparoscopic electro-mechanical morcellator was rare.
Authors: S Suchetha; T Vijayashanti; P Rema; J Sivaranjith; Aswin Kumar; K M Jagathnath Krishna; Francis V James Journal: J Obstet Gynaecol India Date: 2022-02-23
Authors: Maria Ruiz-Minaya; Elsa Mendizabal-Vicente; Wenceslao Vasquez-Jimenez; Laura Perez-Burrel; Irene Aracil-Moreno; Carolina Agra-Pujol; Mireia Bernal-Claverol; Beatriz L Martínez-Bernal; Mercedes Muñoz-Fernández; Melanie Morote-Gonzalez; Miguel A Ortega; Santiago Lizarraga-Bonelli; Juan A De Leon-Luis Journal: J Pers Med Date: 2022-02-06
Authors: S Cabrera; V Bebia; U Acosta; S Franco-Camps; L Mañalich; A García-Jiménez; A Gil-Moreno Journal: Clin Transl Oncol Date: 2020-11-18 Impact factor: 3.405