title: The impact of tumor morcellation during surgery on the outcomes of patients with apparently early low-grade endometrial stromal sarcoma of the uterus.
abstract: BACKGROUND
  The purpose of this study was to evaluate the impact of tumor morcellation on the outcomes of patients with apparently early low-grade endometrial stromal sarcoma (LGESS).
  
  
  METHODS
  Outcomes were retrospectively compared between patients with apparently early LGESS who did not (group A, n=27) or did (group B, n=23) undergo tumor morcellation.
  
  
  RESULTS
  There were no between-group differences in age, menopausal status, parity, body mass index, and preoperative presumptive diagnosis, nor were there between-group differences in tumor stage, tumor size, myometrial invasion, lymphovascular space invasion, frequency of ovarian preservation, adjuvant therapy, or follow-up time. More patients in group A underwent lymph node dissection (51.9 vs. 21.7%; P=0.029). Only 1 patient in each group had distant recurrence. There were 2 patients (7.4%) in group A and 7 (31.4%) in group B who had abdominopelvic recurrence. The risk of abdominopelvic recurrence was significantly higher in group B than in group A (odds ratio [OR], 5.47; 95% confidence interval [95% CI], 1.04-29.70; P=0.035). The 5-year disease-free survival (DFS) rates were 84% for group A and 55% for group B (P=0.028) and the 5-year abdominopelvic DFS rates were 89 and 58% (P=0.023), respectively. Multivariate analysis showed that tumor morcellation were significantly associated with poorer DFS (OR, 4.03; 95% CI, 1.06-15.30; P=0.040) and abdominopelvic DFS (OR, 5.06; 95% CI, 1.02-25.04; P=0.047).
  
  
  CONCLUSIONS
  Inadvertent tumor morcellation during surgery has an adverse impact on the outcomes of patients with early LGESS.
authors.affiliation: Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
authors.forename: Jeong-Yeol
authors.initials: JY
authors.lastname: Park
authors.forename: Dae-Yeon
authors.initials: DY
authors.lastname: Kim
authors.forename: Jong-Hyeok
authors.initials: JH
authors.lastname: Kim
authors.forename: Yong-Man
authors.initials: YM
authors.lastname: Kim
authors.forename: Young-Tak
authors.initials: YT
authors.lastname: Kim
authors.forename: Joo-Hyun
authors.initials: JH
authors.lastname: Nam
mesh_terms: D000328:Adult; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D036821:Endometrial Stromal Tumors / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D055815:Young Adult