Objectives To evaluate the impact of preoperative diagnosis of malignancy on survival in patients surgically treated for apparent early-stage uterine leiomyosarcoma (ULMS).

Methods Data of consecutive patients who underwent total hysterectomy at Del Ponte Hospital, (Varese-Italy) between January 2000 and December 2019 were retrieved. Only cases with histologically proven ULMS at final diagnosis were included and stratified according with the preoperative finding of malignancy into: ‘Suspicious ULMS’ vs. ‘unexpected ULMS’. Demographic, pathologic and surgical-related characteristics were compared. Survivals curves were estimated with Kaplan-Meier methods and predictors of recurrence were investigated.

Results Overall 36 patients ULMS were included, 24 and 12 ‘unexpected ULMS’ and ‘suspicious ULMS’, respectively. No significant differences between the groups in terms of baseline characteristics and surgical approach (minimally-invasive approach: 3, 25% vs. 15, 62.5%, p=0.08) were found. The morcellation of the uterus was less likely performed in patients in ‘suspicious ULMS’ (18, 33% vs.14, 58.33%; p=0.005). The survival analysis did not show statistical differences between the groups. No differences in survival (DFS (log-rank=0.28) and OS (log-rank=0.78).

Details on recurrence are reported (table 1). No predictors of relapse were found, including uterine morcellation (41.67% vs. 66.67%, p=0.15).

Conclusions Patients undergoing hysterectomy for ULMS have poor prognosis regardless the surgical approach. In our population, preoperative suspicious of malignancy did not influence survival outcomes and morcellation did not seem to have a detrimental effect on recurrence rate.

Larger studies are warranted to confirm our findings.