Occult Uterine Sarcoma and Leiomyosarcoma

Raine‐Bennett, Tina; Tucker, Lue-Yen; Zaritsky, Eve; Littell, Ramey D.; Palen, Ted E.; Neugebauer, Romain; Axtell, Allison E.; Schultze, Peter M.; Kronbach, David W.; Embry-Schubert, Julia; Sundang, Alvina; Bischoff, Kimberly; Compton-Phillips, Amy; Lentz, Scott E.

doi:10.1097/aog.0000000000001187

Cited by 99 publications

(24 citation statements)

References 18 publications

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“…We identified 11 studies 10–12,14–21 published since the FDA safety communications of sufficient quality and pertaining to our target population of women undergoing hysterectomy who might be subject to morcellation (Table). The number of subjects ranged from 808–241,114 and LMS rates ranged from 0–0.0032 (1:314).…”

Section: Resultsmentioning

confidence: 99%

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Laparoscopic hysterectomy with morcellation vs abdominal hysterectomy for presumed fibroids: an updated decision analysis following the 2014 Food and Drug Administration safety communications

Siedhoff

Doll

Clarke‐Pearson

et al. 2017

American Journal of Obstetrics and Gynecology

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Previous decision analyses demonstrate the safety of minimally invasive hysterectomy for presumed benign fibroids, accounting for the risk of occult leiomyosarcoma and the differential mortality risk associated with laparotomy. Studies published since the 2014 Food and Drug Administration safety communications offer updated leiomyosarcoma incidence estimates. Incorporating these studies suggests that mortality rates are low following hysterectomy for presumed benign fibroids overall, and a minimally invasive approach remains a safe option. Risk associated with morcellation, however, increases in women age >50 years due to increased leiomyosarcoma rates, an important finding for patient-centered discussions of treatment options for fibroids.

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Section: Resultsmentioning

confidence: 99%

“…10–12 Estimated LMS rates for women age <50 years ranged from 0.0011–0.0013. We selected 0.0012 as our <50-year-old base case.…”

Section: Resultsmentioning

confidence: 99%

Laparoscopic hysterectomy with morcellation vs abdominal hysterectomy for presumed fibroids: an updated decision analysis following the 2014 Food and Drug Administration safety communications

Siedhoff

Doll

Clarke‐Pearson

et al. 2017

American Journal of Obstetrics and Gynecology

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“…However, 9 of 10 women with LMS were peri-or postmenopausal and over 50 years of age. The FDA emphasizes [13] that sarcomas in women undergoing surgeries due to presumed myomas approaches 2-3% in those over 60 years [19][20][21]. It should be highlighted that leyomyosarcomas often are unidentified before surgery as showed the data from the Cancer Registry of Norway [22], and in the Norwegian cohort, power morcellation of LMS has not led to reduced survival.…”

Section: Discussionmentioning

confidence: 99%

“…In our study the woman with LMS who underwent power morcellation is 1 of 3 women with the longest survival after LMS recognition from the case series. However, several new studies included in the recent FDA review [13] provide some evidence supporting an increased risk of relapse and decreased overall survival after power morcellation of LMS [19,23,24]. Conversely, another interpretation of the available data suggests that even intact removal of LMS has no advantage for mortality rate compared with power or any other type of morcellation [25].…”

Section: Discussionmentioning

confidence: 99%

Occult uterine leiomyosarcoma in women undergoing abdominal and minimally invasive surgeries for myomas

2018

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Objectives: To estimate (i) the incidence of occult uterine leiomyosarcoma (LMS) in patients operated on for presumed myomas, and (ii) the proportion of occult LMS to preoperatively diagnosed LMS in a tertiary center. Material and methods: An Institutional Review Board-approved retrospective cohort study was performed. The electronic database of 30,476 patients was searched for women who had undergone surgery due to presumed myomas (N = 2675) as well as those with uterine LMS recognized via histology (N = 10) between January 2010 and December 2016. Results: Six of the 2675 treated women had occult LMS (incidence 1:446; 0.002; CI 0.0-0.013), and one underwent power morcellation (incidence 1:951; 0.001; CI 0.0-0.006). Parallel searching revealed that 6 of the 10 cases (60%) with uterine LMS recognized via histology were diagnosed postoperatively, whereas 4 of the 10 (40%) were diagnosed preoperatively. The incidence of LMS morcellation during laparoscopy was 1:951 and, when all MIS cases were included, 1:1178. The patient who underwent LMS morcellation was operated in the general surgery ward 5 years after laparoscopy (omental recurrence). Conclusions: These results are similar to the first and recent conservative FDA estimations, but two-times lower for procedures with laparoscopic morcellation and all MIS procedures than for abdominal. Because above half of LMS may be recognized after surgery, the risk of occult LMS and the delay of targeted surgical treatment should be included in all informed consent forms for conservative management of presumed myomas without histology.

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“…Among them, 34 cases (28%) incurred uterus morcellation, which may increase the risk of postoperative metastasis within three months. Recently, other studies also showed that laparoscopic surgery may lead to malignant planting in operating hole, abdominal and pelvic sarcoma 11 49 51 52 53 .…”

Section: Uterus Morcellation and Metastasis Of Uterine Sarcomamentioning

confidence: 99%

Laparoscopic surgery on broken points for uterine sarcoma in the early stage decrease prognosis

Liu

Zhu

Zhang

et al. 2016

Sci Rep

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Uterine sarcoma, a rare solid tumor in uterus, is difficult to identify in the early stage from some benign uterine tumors, such as uterine fibroids. Hence, uterine sarcoma may be treated in the same way as uterine fibroids; and this may not be found until pathological diagnosis. Consequently, this can lead to tumor’s abdominal spread, planting and local invasive growth, resulting in an early uterine sarcoma, an increased relapse rate after surgery and a decreased survival. Therefore, it’s important to avoid these unintended and iatrogenic complications through an accurate diagnosis and an appropriate surgical approach. The surgical staging and a complete resection of the tumor are both important for patients’ prognosis. In this review, we will discuss the laparoscopic surgery for uterine sarcoma in the early stage and patients’ prognosis.

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Occult Uterine Sarcoma and Leiomyosarcoma

Abstract: Morcellation is associated with decreased early survival of women with occult leiomyosarcomas. We could not accurately assess associations between power morcellation and 3-year survival as a result of small numbers.

Cited by 99 publications

References 18 publications

Laparoscopic hysterectomy with morcellation vs abdominal hysterectomy for presumed fibroids: an updated decision analysis following the 2014 Food and Drug Administration safety communications

Laparoscopic hysterectomy with morcellation vs abdominal hysterectomy for presumed fibroids: an updated decision analysis following the 2014 Food and Drug Administration safety communications

Occult uterine leiomyosarcoma in women undergoing abdominal and minimally invasive surgeries for myomas

Laparoscopic surgery on broken points for uterine sarcoma in the early stage decrease prognosis

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