Morcellation worsens survival outcomes in patients with undiagnosed uterine leiomyosarcomas: A retrospective MITO group study.
OBJECTIVE
To investigate the impact of morcellation on survival outcomes of patients affected by undiagnosed uterine sarcoma.


METHODS
This is a retrospective study performed in 8 referral centers of MITO group. Data of women undergoing morcellation for apparent benign uterine myomas who were ultimately diagnosed with stage I uterine sarcoma on final pathology were compared with data of women who did not undergo morcellation. Uterine sarcoma included: leiomyosarcomas (LMS), smooth muscle tumors of uncertain malignant potential (STUMP), low-grade endometrial stromal sarcomas (LG-ESS) and undifferentiated uterine sarcomas (UUS). Two-year survival outcomes were evaluated using Kaplan-Meir and Cox models.


RESULTS
Overall 125 patients were identified: 31(24.8%), 21(16.8%) and 73(58.4%) patients had power morcellation during laparoscopy, non power morcellation during open surgery and non morcellation during open procedures, respectively. Considering patients affected by LMS, morcellation did not correlated with disease-free survival. However, patients undergoing either morcellation or power morcellation experienced a 3-fold increase risk of death in comparison to patients who had not morcellation (p=0.02). A trend towards an increase of recurrence was observed for patients undergoing morcellation for STUMP (HR 7.7, p=0.09); while no differences in survival outcomes were observed for patients with LG-ESS and UUS.


CONCLUSIONS
Our data suggest that morcellation increase the risk of death in patients affected by undiagnosed LMS. Further prospective studies are warranted in order to assess the risk to benefit ratio of power morcellator utilization in patients with apparent benign uterine myomas.
Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Gynecologic Oncology, Milan, Italy.
Francesco
F
Raspagliesi
Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Gynecologic Oncology, Milan, Italy.
Giuseppa
G
Maltese
Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Gynecologic Oncology, Milan, Italy.
Giorgio
G
Bogani
Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Medical Oncology, Milan, Italy.
Giovanni
G
Fucà
Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Gynecologic Oncology, Milan, Italy.
Stefano
S
Lepori
University of Bologna, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, S. Orsola Hospital, Bologna, Italy.
Pierandrea
P
De Iaco
University of Bologna, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, S. Orsola Hospital, Bologna, Italy.
Myriam
M
Perrone
Catholic University of The Sacred Heart, Division of Gynecologic Oncology, Rome, Italy.
Giovanni
G
Scambia
Oncology Institute "Giovanni Paolo II", Bari, Italy; University of Bari, Gynecologic Oncology Unit, Bari, Italy.
Gennaro
G
Cormio
IRCCS Fondazione Policlinico San Matteo, University of Pavia, Department of Obstetrics and Gynecology, Pavia, Italy.
Stefano
S
Bogliolo
San Raffaele Hospital, Department of Obstetrics and Gynecology, Milan, Italy.
Alice
A
Bergamini
University of Naples "Federico II", Department of Neuroscience and Reproductive and Odontostomatologic Science, Naples, Italy.
Giuseppe
G
Bifulco
Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Medical Oncology, Milan, Italy.
Paolo Giovanni
PG
Casali
Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Gynecologic Oncology, Milan, Italy. Electronic address: domenica.lorusso@istitutotumori.mi.it.
Domenica
D
Lorusso
D000328:Adult; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007889:Leiomyoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D007890:Leiomyosarcoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D000069577:Morcellation / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D018235:Smooth Muscle Tumor / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D013534:Survival; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery*
Laparoscopy; Morcellation; Myoma; Sarcoma; Survival