Highlights of Morcellation and Sarcoma Incidence in German Patients Admitted for Uterine Fibroid Surgery [12B

Abstract

INTRODUCTION: To assess the incidence and frequency of unsuspected cases of uterine sarcomas among patients undergoing surgery for benign uterine fibroids in Germany. METHODS: This was a retrospective single-center study at a university hospital. The records of patients with uterine fibroids and uterine sarcoma from 2003 to 2015 were reviewed. RESULTS: A total of 2,275 patients were included. Preoperatively, 2,269 patients had presumed benign uterine fibroids, and 6 patients had suspected uterine sarcoma. Among the 2,269 patients who underwent surgery for presumed uterine fibroids, only one patient (0.044%, 95% CI: 0.001%-0.25%) histopathologically revealed endometrial stromal sarcoma (ESS) after laparoscopic subtotal hysterectomy (LSH) with morcellation(48 years old). Six patients were diagnosed with uterine sarcoma preoperatively and underwent a direct open conventional cancer treatment. Histopathological analyses confirmed four cases of uterine leiomyosarcoma (ULMS) mean age 73.7 ± 3.9, one high-grade undifferentiated uterine sarcoma (HGUS), and one embryonal rhabdomyosarcoma (ERMS). Altogether, seven of the 2,275 women (0.31%, 95% CI: 0.12%-0. 63%) were diagnosed with uterine sarcomas over this twelve-year period. CONCLUSION: The frequency of unsuspected uterine sarcoma was 1/2,269 (0.044%) among the women who underwent myomectomies and hysterectomies to treat presumed benign uterine fibroids. The total incidence of uterine sarcoma was 7/2,275 (0.31%) among the women who had presumed uterine fibroids or a suspected uterine sarcoma before undergoing the surgical procedures. Shall we continue with unprotected morcellation.