title: Uterine leiomyosarcoma - incidence, treatment, and the impact of morcellation. A nationwide cohort study.
abstract: BACKGROUND
  The risk of morcellation of occult uterine leiomyosarcomas (LMS) during laparoscopic procedures has been under scrutiny over recent years. The objective of this study was to assess the operative treatment performed in women with uterine LMS in Norway in 2000-2012, including the number of morcellated LMS.
  
  
  METHODS
  Retrospective nationwide cohort study. The study participants were all women with histopathologically verified uterine LMS in Norway during 2000-2012. The data were collected from the Cancer Registry of Norway, National Patient Registry and medical records.
  
  
  RESULTS
  There were 212 women diagnosed with uterine LMS in Norway in 2000-2012. Mean age at time of diagnosis was 58.1 years (SD ± 12.5). The most frequent symptom in women suffering from LMS was abnormal uterine bleeding [110/212 (51.9%)]. LMS was histopathologically verified in 49/212 (23.1%) preoperatively. In 48/212 (22.6%), a malignant condition was suspected and they were treated accordingly. In 115/212 (54.2%), malignancy was not suspected at time of surgery and the women were treated according to the treatment protocol for fibroids. In only four patients was tissue retrieval by power morcellation conducted, accounting for 1.9% of all LMS cases.
  
  
  CONCLUSIONS
  In more than 50% of women suffering from LMS, a malignant diagnosis was not confirmed or suspected prior to surgery. In our material, power morcellation of LMS has not lead to reduced survival. We suggest that power morcellators may be used in surgical treatment of selected cases of premenopausal women with symptomatic, presumed benign uterine leiomyomas.
authors.affiliation: Department of Obstetrics and Gynecology, Vestfold Hospital, Tonsberg, Norway.
authors.forename: Mette
authors.identifier: http://orcid.org/0000-0003-1474-0563
authors.initials: M
authors.lastname: Skorstad
authors.affiliation: Department of Gynecology, Royal Surrey Hospital, Guildford, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kent
authors.affiliation: Department of Gynecology, Oslo University Hospital, Oslo, Norway.|Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Marit
authors.initials: M
authors.lastname: Lieng
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D015994:Incidence; D007889:Leiomyoma / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D007890:Leiomyosarcoma / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D008595:Menorrhagia / Q000453:epidemiology / Q000209:etiology; D008875:Middle Aged; D000069577:Morcellation; D009664:Norway / Q000453:epidemiology; D009852:Omentum / Q000601:surgery; D017699:Pelvic Pain / Q000453:epidemiology / Q000209:etiology; D017698:Postmenopause; D012189:Retrospective Studies; D014592:Uterine Hemorrhage / Q000453:epidemiology / Q000209:etiology; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*
keywords: Leiomyosarcoma; fibroma; hysterectomy; laparoscopic hysterectomy; laparoscopy; morcellation; uterine neoplasms