Introduction/Background Morcellation has been thought as a risk factor of recurrence or abdominopelvic disease dissemination during surgery for uterine sarcoma. On the strength of advancement in diagnostic technology, capability to predict sarcoma is slightly improved than before. The purpose of this study is to re-evaluate the morcellation in the aspect of risk factor for outcome.
Methodology From 2007 to 2017, 123 patients who were treated for stage 1–2 uterine sarcoma including leiomyosarcoma, low-grade endometrial stromal sarcoma (ESS), high-grade ESS were analysed retrospectively.
Results Among 123 patients, 96 (78%) had surgery in the presumed benign disease and 53(43%) underwent morcellation to remove uterine mass (morcellation group). Recurrence was detected in 41 (33.3%) patients and 37 cases showed abdomino-pelvic recurrence. There was no statistically significant difference in all types of recurrent rate (34.3% vs. 32.1%, p=0.797), abdomino-pelvic recurrent rate (31.9% vs. 30.0%, p=0.827) and survival rate (82.9% vs. 84.9%, p=0.76) between two group (non-morcellation vs. morcellation). Estimated disease free interval were 92.6 months (95% confidence interval (CI), 73.3–112.0 months) for non-morcellation group and 86.0 months (95% CI, 72.3–99.6 months) for morcellation group. Estimated 5-year disease free survival (DFS) rate was 68.5% and 70.2% (p=0.996) in the non-morcellation and morcellation group, respectively. Estimated 5-year overall survival (OS) was not statistically different between two groups (76.7% vs. 83.1% p=0.762) and morcellation was not associated with all types of recurrence (odds ratio (OR), 0.905; 95% CI 0.424–1.934), abdomino-pelvic recurrence (OR, 0.916; 95% CI 0.416–2.015) and OS (OR, 0.991; 95% CI 0.279–3.513; p=0.989).
Conclusion In the patients with the early stage of uterine sarcoma, morcellation during the first operation is not associated with the recurrence or overall survival. However, this contradiction to current knowledge needs further validation through multi-centre study of large sample size.
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