title: Is open surgery the solution to avoid morcellation of uterine sarcomas? A systematic literature review on the effect of tumor morcellation and surgical techniques.
abstract: OBJECTIVE
  Today's surgical standard of care for uterine leiomyomas is laparoscopic and/or vaginal surgery with larger specimens requiring morcellation to avoid open surgery. This is often associated with intra-abdominal dissemination of cellular material which in case of a uterine sarcoma might result in iatrogenic seeding of malignant tumor cells. The aim of this systematic literature review is to evaluate the surgical techniques and the impact of accidental tumor morcellation on the outcome of patients postoperatively diagnosed with malignant uterine sarcomas.
  
  
  METHODS
  The National Library of Medicine database (pubmed) and Web of science were searched individually using three different search terms ('morcel* sarcoma', 'survival, sarcoma, treatment, Uter*', and 'disease free survival, sarcoma, treatment, uter*'). After excluding duplicates and screening for relevance, 16 articles were left for full-text review, resulting in seven case series with more than 5 patients.
  
  
  RESULTS
  The case numbers range from 14 to 123 patients with the majority of cases being leiomyosarcomas.
  
  
  CONCLUSIONS
  There is no reliable diagnostic tool to differentiate a fibroid from a uterine sarcoma preoperatively. Tumor morcellation occurs in various open and closed surgical techniques and is not limited to laparoscopic surgery only. There is an urgent need for a presurgical diagnostic parameter.
authors.affiliation: Universitätsfrauenklinik Ulm, Prittwitzstr. 43, 89075, Ulm, Germany, florian.ebner@uniklinik-ulm.de.
authors.forename: Florian
authors.initials: F
authors.lastname: Ebner
authors.forename: Thomas W P
authors.initials: TW
authors.lastname: Friedl
authors.forename: Christoph
authors.initials: C
authors.lastname: Scholz
authors.forename: Fabienne
authors.initials: F
authors.lastname: Schochter
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Janni
authors.forename: Elena
authors.initials: E
authors.lastname: Vorwerk
authors.forename: Nikolaus
authors.initials: N
authors.lastname: deGregorio
mesh_terms: D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods; D007890:Leiomyosarcoma / Q000601:surgery*; D008875:Middle Aged; D000069577:Morcellation; D012509:Sarcoma / Q000473:pathology / Q000601:surgery*; D014594:Uterine Neoplasms / Q000601:surgery*