Objectives UCS comprises <5% of uterine malignancies, accounting for >15% associated mortality. With no established guidelines, we present our experience to determine clinical characteristics, treatment modalities and histology outcomes of UCS.

Methods We conducted a multicentre retrospective cohort study, including all surgically managed UCS cases between March 2010 and January 2020. Data was collected on patients’ demographics, medical history, pre-operative and final histology and FIGO staging, peri-operative and post-operative findings.

Results 82 (9.7%) UCS cases were identified from a total of 847 surgically managed uterine cancers, with 51 diagnosed with UCS. 3 cases were down and 12 up-staged following surgery. 15 cases of MRI lymphadenopathy led to a PPV of 40%. Positive lymph nodes and omentum were identified in 15.8% and 11.3% of cases respectively, with half of lymph node metastases diagnosed following systematic dissection (the majority of which were LVSI positive). There were no operative complication themes.

Conclusions UCS presented with almost double the incidence rate previously described. The overall accuracy of pre-operative staging was 81%. Our analysis showed that 86% of cases were managed laparoscopically, with more favourable peri-operative and post-operative profiles. Despite the lack of management guidelines, we stress the importance of urgent surgical treatment for UCS, in the form of total hysterectomy, bilateral salpingo-oophorectomy, systematic bilateral pelvic lymph node dissection and omentectomy. Data on adjuvant treatment, recurrence and survival is currently under analysis.