Abstract
Laparoscopic myomectomy is a minimally invasive, conservative surgical approach commonly used for the treatment of uterine fibroids. However, there is a lack of effective means to distinguish the nature of uterine tumors prior to surgery. The impact of fibroid morcellation during laparoscopic surgery on the dissemination of cancerous uterine fibroids and long-term survival of patients has gained increasing attention. A retrospective cohort study was conducted to analyze the impact of different surgical approaches on recurrence-free survival (RFS) and overall survival (OS) in patients with a postoperative pathological diagnosis of uterine sarcoma at a single medical center. Patients who underwent the first surgery for uterine fibroids (confined to the uterus) and had a postoperative pathological diagnosis of uterine sarcoma were selected in the Chinese PLA General Hospital from January 2005 to January 2014. Based on the use of fibroid morcellation, the subjects were divided into fibroid morcellation (FM) and total hysterectomy (TH, non-morcellation) groups. Follow-up outcomes, including RFS and OS times, were observed. In total, 59 patients were included, with 30 cases in the FM group and 29 cases in the TH group. There were no significant differences in RFS and OS time between the two groups (RFS: P = 0.16, OS: P = 0.09). Multivariate correlation analysis showed that the impact of a higher grade level on RFS and OS was nearly 2-fold the impact of a lower grade level (RFS: P = 0.04, odds ratio (OR) = 1.97; OS: P = 0.03, OR = 2.29). Intraoperative morcellation, postoperative adjuvant therapy, age, tumor size, FIGO stage, and surgical approach were not risk factors affecting RFS and OS. Fibroid morcellation during laparoscopic surgery (including laparoscopic, transvaginal and transabdominal approaches) had no significant impact on RFS and OS time in patients. However, the 5-year RFS and OS rates were both lower in the FM group than in the TH group. Grade level was a significant risk factor for the prognosis of patients with uterine sarcoma.
Highlights
Uterine sarcomas are a rare type of gynecologic cancer, accounting for ~3% of uterine malignancies
Laparoscopic myomectomy has become a minimally invasive, conservative surgical approach commonly used in the treatment of uterine fibroids
The prevalence rate of uterine sarcoma in the laparoscopic myomectomy group was lower than the other two groups, and the analysis of the reasons may be related to the limitations of laparoscopic surgery
Summary
Uterine sarcomas are a rare type of gynecologic cancer, accounting for ~3% of uterine malignancies. Among the three pathological types, LMS is the most common uterine sarcoma [1, 2] and may have an origin in malignant uterine leiomyomas ( known as fibroids). The US Food and Drug Administration (FDA) released a warning in 2014 [10] that the application of a laparoscopic electric morcellator in patients with unpredictable uterine sarcoma can increase the risk of dissemination of tumor tissue in the abdominopelvic cavity, affecting patient long-term survival rates. Clinical trials about the impact of laparoscopic myomectomy on long-term survival of patients are currently rare in China. The present study provided a retrospective analysis on the incidence and long-term follow-up of uterine sarcoma following laparoscopic myomectomy for uterine fibroids. The impact of laparoscopic myomectomy on the long-term survival time of patients was analyzed to guide clinical applications
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