title: Retrospective cohort study evaluating the impact of intraperitoneal morcellation on outcomes of localized uterine leiomyosarcoma.
abstract: BACKGROUND
  Uterine leiomyosarcoma (ULMS) is identified in 0.1% to 0.2% of hysterectomy specimens of presumed leiomyoma. To date, there is no preoperative technique that reliably differentiates ULMS from uterine leiomyoma. Increasing use of minimally invasive approaches for the management of leiomyomas may result in inadvertently morcellated ULMS with resultant intraperitoneal dissemination of tumor. The objective of this study was to assess the impact of intraperitoneal morcellation on the outcomes of patients with ULMS.
  
  
  METHODS
  In this retrospective cohort study, all patients with ULMS who attended the authors' institutions from 2007 to 2012 were reviewed. Demographics and outcomes were compared between those who underwent morcellation or total abdominal hysterectomy (TAH) as their first surgery for uterus-limited ULMS.
  
  
  RESULTS
  In total, 58 patients were identified, including 39 who underwent TAH and 19 who underwent intraperitoneal morcellation. Intraperitoneal morcellation was associated with a significantly increased risk of abdominal/pelvic recurrences (P = .001) and with significantly shorter median recurrence-free survival (10.8 months vs 39.6 months; P = .002). A multivariate adjusted model demonstrated a > 3 times increased risk of recurrence associated with morcellation (hazard ratio, 3.18; 95% confidence interval, 1.5-6.8; P = .003).
  
  
  CONCLUSIONS
  Intraperitoneal morcellation of presumed leiomyoma worsens the outcomes of women with ULMS. Because there are no reliable preoperative techniques to distinguish ULMS from benign leiomyoma, all efforts to minimize intraperitoneal uterine morcellation should be considered. [See editorial on pages 000-000, this issue.]
authors.affiliation: Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
authors.forename: Suzanne
authors.initials: S
authors.lastname: George
authors.forename: Constance
authors.initials: C
authors.lastname: Barysauskas
authors.forename: César
authors.initials: C
authors.lastname: Serrano
authors.forename: Titilope
authors.initials: T
authors.lastname: Oduyebo
authors.forename: Jose A
authors.initials: JA
authors.lastname: Rauh-Hain
authors.forename: Marcela G
authors.initials: MG
authors.lastname: Del Carmen
authors.forename: George D
authors.initials: GD
authors.lastname: Demetri
authors.forename: Michael G
authors.initials: MG
authors.lastname: Muto
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007890:Leiomyosarcoma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: hysterectomy; morcellation; outcomes; uterine leiomyosarcoma; uterine sarcoma