title: Impact of Surgery on the Evolution of Uterine Sarcomas.
abstract: OBJECTIVE
  To identify the characteristics of uterine sarcomas and assess the impact of morcellation on prognosis.
  
  
  METHODS
  Case-control study. (Canadian Task Force classification II-2).
  
  
  METHODS
  Hospital Quiron-Dexeus, an academic hospital.
  
  
  METHODS
  Patients with uterine sarcoma histologically diagnosed and treated in our center between 1987 and 2013.
  
  
  METHODS
  All descriptive data, including type of surgery and clinical and pathological data, were reviewed. Survival analysis was performed comparing patients with hysterectomy/myomectomy without any type of morcellation and patients with morcellation during surgery.
  
  
  RESULTS
  A total of 37 sarcomas were diagnosed during the study period. The most common symptom was metrorrhagia (50%). The indication for surgery was related to myoma growth in 40% of cases and to metrorrhagia in 37.1% of cases. Open surgery was performed in 23 patients (62.2%), and laparoscopy was performed in 9 (24.3%). Myomectomy was performed in 14 patients (37.8%), and 23 patients (62.1%) underwent hysterectomy as initial surgery. Morcellation for tumor extraction was done in 8 cases (21.6%). Survival analysis by surgical approach showed increased disease-free survival (DFS) in the laparotomy group compared with the laparoscopy group (median, 70.3 months vs 10.4 months; p = .018). Median DFS according to type of surgery was 6.3 months in morcellation cases, 11.9 months in vaginal fragmentation cases, and 149.9 months in nonmorcellated cases (p < .002). The median time to progression was shorter in morcellated cases (laparocopic and vaginal) compared with nonmorcellated cases (11.9 vs 14.9 months; p < .001). No statistically significant differences in prognosis were related to myomectomy versus hysterectomy; however, there were significants difference between morcellation and nonmorcellation cases.
  
  
  CONCLUSIONS
  Taking into account the negative impact of morcellation in sarcomas, the use of this technique should be reconsidered in cases of myoma with atypical clinical presentation or symptomatology. Patients must be informed about the possibility of a nonidentified sarcoma and the possible impact on prognosis resulting from its morcellation.
authors.affiliation: Gynecology Oncology Unit, Department of Obstetrics, Gynecology, and Human Reproduction, Hospital Universitari Quiron-Dexeus, Barcelona, Spain. Electronic address: maicus@dexeus.com.
authors.forename: Maite
authors.initials: M
authors.lastname: Cusidó
authors.affiliation: Gynecology Oncology Unit, Department of Obstetrics, Gynecology, and Human Reproduction, Hospital Universitari Quiron-Dexeus, Barcelona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Fargas
authors.affiliation: Gynecology Oncology Unit, Department of Obstetrics, Gynecology, and Human Reproduction, Hospital Universitari Quiron-Dexeus, Barcelona, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Baulies
authors.affiliation: Gynecology Oncology Unit, Department of Obstetrics, Gynecology, and Human Reproduction, Hospital Universitari Quiron-Dexeus, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Plana
authors.affiliation: Statistical Unit, Department of Obstetrics, Gynecology, and Human Reproduction, Hospital Universitari Quiron-Dexeus, Barcelona, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Rodríguez
authors.affiliation: Pathology Unit, Department of Obstetrics, Gynecology, and Human Reproduction, Hospital Universitari Quiron-Dexeus, Barcelona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Tresserra
authors.affiliation: Diagnostic Imaging Unit, Department of Obstetrics, Gynecology, and Human Reproduction, Hospital Universitari Quiron-Dexeus, Barcelona, Spain.
authors.forename: M A
authors.initials: MA
authors.lastname: Pascual
authors.affiliation: Gynecology Oncology Unit, Department of Obstetrics, Gynecology, and Human Reproduction, Hospital Universitari Quiron-Dexeus, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Fábregas
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D010535:Laparoscopy / Q000379:methods; D007813:Laparotomy / Q000379:methods; D008796:Metrorrhagia / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D011379:Prognosis; D012509:Sarcoma / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D063186:Uterine Myomectomy / Q000379:methods; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Morcellation; Prognosis; Recurrence; Surgery; Uterine sarcoma