Unsuspected Uterine Sarcoma in an Urban Hospital: Does Surgical Approach Matter?

DiNapoli, Marianne; Truong, Mireille; Halfon, Johanna; Burke, William M.

doi:10.1016/j.jmig.2017.10.014

Cited by 4 publications

(3 citation statements)

References 31 publications

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“…A review of the literature shows that while the incidence of occult uterine leiomyosarcoma in patients who undergo only hysterectomies can be 0.89% at the highest [15], the incidence of occult uterine leiomyosarcoma varies between 0.20% and 0.38% when all patients who underwent hysterectomy and myomectomy are included in the analysis [20,21]. In our study, the incidence of leiomyosarcoma was calculated to be 0.08%, which is relatively lower than that reported in other studies.…”

Section: Discussioncontrasting

confidence: 67%

Evaluation of occult uterine leiomyosarcomas

et al. 2019

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Objectives:To determine the frequency of occult uterine leiomyosarcomas following hysterectomies and myomectomies performed for benign reasons at our clinic and to draw comparisons with similar studies in the literature. Material and methods:All hysterectomies and myomectomies that have been performed for benign reasons at our clinic between 2010 and 2017 were retrospectively examined via the hospital's information system and the patients that were found to have leiomyosarcomas were analysed. The incidence of occult uterine leiomyosarcoma per 1000 surgeries at our clinic was calculated using the Wilson score interval.Results: A total of 6,173 hysterectomies were performed, and occult uterine leiomyosarcoma was identified in 5 patients. The incidence of occult uterine leiomyosarcoma was calculated to be 0.08% (95% CI 0.03-0.018%). Only 1 of the 771 patients who underwent myomectomy was identified with occult uterine leiomyosarcoma, making its incidence in myomectomy 0.12% (95% CI 0.02-0.073%). When all the patients are considered, occult uterine leiomyosarcoma was identified in 6 of the 6,944 patients, and the general incidence of occult uterine leiomyosarcoma was calculated as 0.08% (95% CI 0.03-0.018%). Conclusions:In our study, the incidence of occult uterine sarcoma following myomectomy and hysterectomy was found to be lower than that reported in the literature. The reason for this lower incidence includes not only genetic causes and racial differences but also preoperative imaging, endometrial and cervical sampling that is performed on every patient.

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Section: Discussioncontrasting

confidence: 67%

Evaluation of occult uterine leiomyosarcomas

et al. 2019

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“…Consequently, there is a risk that patients, initially diagnosed with a large leiomyoma, may undergo MIS without the awareness of an underlying mesenchymal malignancy [21].…”

Section: Introductionmentioning

confidence: 99%

Infectious Complications in Laparoscopic Gynecologic Oncology Surgery within an ERAS-Compliant Setting

Capozzi,

De Finis,

Scarpelli

et al. 2024

JPM

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Minimally Invasive Surgery (MIS) represents a safe and feasible option for the surgical treatment of gynecologic malignancies, offering benefits, including reduced blood loss, lower complications, and faster recovery, without compromising oncological outcomes in selected patients. MIS is widely accepted in early-stage gynecologic malignancies, including endometrial cancer, cervical tumors measuring 2 cm or less, and early-stage ovarian cancer, considering the risk of surgical spillage. Despite its advantages, MIS does not rule out the possibility of adverse events such as postoperative infections. This retrospective study on 260 patients undergoing laparoscopic surgery at Parma University Hospital for gynecologic malignancies explores the incidence and risk factors of postoperative infectious complications. The Clavien-Dindo classification was used to rank postoperative surgical complications occurring 30 days after surgery and Enhanced Recovery After Surgery (ERAS) recommendations put into practice. In our population, 15 (5.8%) patients developed infectious complications, predominantly urinary tract infections (9, 3.5%). Longer surgical procedures were independently associated with higher postoperative infection risk (p = 0.045). Furthermore, C1 radical hysterectomy correlated significantly with infectious complications (p = 0.001, OR 3.977, 95% CI 1.370–11.544). In conclusion, compared to prior research, our study reported a lower rate of infectious complications occurrence and highlights the importance of adopting infection prevention measures.

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“…Raine-Bennett T et al [16] showed the incidence of occult uterine sarcomas identified during hysterectomies performed for leiomyomas was 1/278 or 3.60 (95% confidence interval [CI] 2.97-4.23) per 1000 hysterectomies. The incidence was similar in open abdominal surgery and laparoscopy (3/743 vs. 1/1216; p = 0.16) [21]. In 2014 FDA stated that tumor morcellation used for laparoscopic myomectomy or hysterectomy is associated with increased risk for spreading cancer and restricts the usage of tumor morcellation [22].…”

Section: Introductionmentioning

confidence: 99%

Cytoreduction can reduce the recurrence rate of patients with occult uterine sarcoma undergoing morcellation: a retrospective study

Ding¹,

Zhu²

2022

Clin. Exp. Obstet. Gynecol.

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Background: Tumor morcellation happened to facilitate iatrogenic metastasis for patients with occult uterine sarcoma. The optimal completion surgery for these patients needed to be established. Methods: Data were retrospectively collected and analyzed from patients with occult uterine sarcoma undergoing morcellation. Results: 19 consecutive patients with uterine sarcomas undergoing morcellation were accessed between January 2008 and December 2018, including 12 patients with uterine leiomyosarcoma and 7 with endometrial stromal sarcoma. Compared with a simple hysterectomy and individualized surgical resection for suspicious extra-uterine lesions, cytoreduction was significantly associated with a lower recurrence rate (p = 0.017), and none of the seven patients undergoing cytoreduction suffered a recurrence. However, the interval between the initial operation and re-operation, transabdominal route (laparoscopic vs. open surgery), and adjuvant therapy had no such significant difference. Conclusions: Cytoreduction was considered as the optimal completion surgery for patients with occult uterine sarcoma undergoing morcellation.

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Unsuspected Uterine Sarcoma in an Urban Hospital: Does Surgical Approach Matter?

Abstract: The incidence of unsuspected uterine sarcoma during myomectomy or hysterectomy for benign indications is low at our institution, and is similar for open and MIS cases. Patients should be counseled on the risks and benefits of both open surgery and MIS approaches.

Cited by 4 publications

References 31 publications

Evaluation of occult uterine leiomyosarcomas

Evaluation of occult uterine leiomyosarcomas

Infectious Complications in Laparoscopic Gynecologic Oncology Surgery within an ERAS-Compliant Setting

Cytoreduction can reduce the recurrence rate of patients with occult uterine sarcoma undergoing morcellation: a retrospective study

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