title: Uterine leiomyosarcoma: does the primary surgical procedure matter?
abstract: BACKGROUND
  Uterine leiomyosarcoma (LMS) has a poor prognosis even after early-stage diagnosis. Because there are no accurate diagnostic tools for preoperatively distinguishing LMS from uterine leiomyoma, surgeons might opt for partial surgical procedures such as myomectomy or subtotal hysterectomy. We sought to determine whether a surgical procedure that cuts through the tumor influences prognosis.
  
  
  METHODS
  Demographic and clinical data of consecutive patients with stage I LMS treated between 1969 and 2005 were reviewed. The study population was divided into group A: patients whose first surgical intervention was total hysterectomy (n = 21); and group B: patients who underwent procedures involving tumor injury, for example, myomectomy, laparoscopic hysterectomy with a morcellator knife, or hysteroscopic myomectomy (n = 16). Survival rates were analyzed and compared. A Cox proportional hazards model was used to assess the association between variables of interest and prognosis.
  
  
  RESULTS
  The median age at diagnosis was 50 years (range, 30-74 years). Median follow-up duration was 44 months. The 2 groups did not differ significantly in age at diagnosis, menopausal status, gravidity, parity, postoperative radiotherapy, or time to last follow-up. Kaplan-Meier curves showed significantly better survival rates (P = 0.04) and a significant advantage in recurrence rate (P = 0.03) for group A compared with group B. Survival in group A was 2.8-fold better than that in group B (95% confidence interval, 1.02-7.67). These estimates remained stable after adjustment for age, menopausal status, and radiotherapy.
  
  
  CONCLUSIONS
  In patients with stage I LMS, primary surgery involving tumor injury seems to be associated with a worse prognosis than total hysterectomy as a primary intervention.
authors.affiliation: Department of Gynecological Oncology, Sheba Medical Center, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. tamar.perri@mail.mcgill.ca.
authors.forename: Tamar
authors.initials: T
authors.lastname: Perri
authors.forename: Jacob
authors.initials: J
authors.lastname: Korach
authors.forename: Siegal
authors.initials: S
authors.lastname: Sadetzki
authors.forename: Bernice
authors.initials: B
authors.lastname: Oberman
authors.forename: Eddie
authors.initials: E
authors.lastname: Fridman
authors.forename: Gilad
authors.initials: G
authors.lastname: Ben-Baruch
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007890:Leiomyosarcoma / Q000601:surgery*; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014594:Uterine Neoplasms / Q000601:surgery*