Results of an internal audit on the survival of patients with uterine sarcoma
Journal Title: Journal of the Turkish-German Gynecological Association - Year 2019, Vol 20, Issue 1
Abstract
Objective: In the last 5 years there has been much discussion about the surgical procedure for uterine fibroids, and essentially, also uterine sarcoma. Still there exists no reliable presurgical diagnostic tool to differentiate between benign fibroids and uterine sarcomas. The aim of this study was to confirm the suspected association between intraoperative spread of tumor by morcellation and impaired outcomes in patients with sarcoma. Material and Methods: After the local ethics commission positively reviewed the study protocol, the oncologic database of our university hospital was retrospectively reviewed for patients with uterine sarcomas over a time period of 13 years (2002-2015). Data was extracted from the medical files and survival information was collected by contacting the patient’s general practitioners if last follow-up-status was older than 6 months. For the analysis, patients were split into two groups with either intrasurgical morcellation (M+) or no morcellation (M-) regarding information provided by the surgical report. Results: Data on 57 patients with uterine sarcoma were available for further analysis. The median age and body mass index of the patients was 63 years and 27 kg/m², respectively. The sarcoma subtypes were 25 leiomyosarcoma, 19 carcinosarcoma, 9 endometrioid stroma sarcoma, 3 adenosarcoma, and one case without further differentiation. In the majority, no morcellation was performed (M- group, n=44) and 51 patients received open surgery (3 laparoscopic, 1 vaginal, and 2 incomplete surgeries). The median time of follow-up was 31 months. The disease-free survival was 50.5 months and the Cox regression analysis showed a hazard ratio of 3.06 [no significant difference between the two subgroups (p=0.079; 95% confidence interval (CI): 0.9-10.6)]. The overall survival was found as 62.2 months and the Cox regression analysis showed a hazard ratio of 3.216 with a statistically significant difference between the two subgroups (p=0.013; 95% CI: 1.3-8.1). Conclusion: Despite the efforts to find a pre-surgical diagnostic tool, the clinical situation remains unsatisfactory. Overall sarcoma prevalence is low during the last 13 years at our university center, but morcellation occurred in a relevant portion of patients (13 of 57). If sarcoma is suspected or diagnosed then en-bloc resection of the uterus can prolong survival. Thus, morcellation of the uterus and not the surgical technique (en-bloc resection) is the prognostic factor and should be avoided in any suspicious case. (J Turk Ger Gynecol Assoc 2019; 20: 15-22)
Authors and Affiliations
Florian Ebner, Saskia Wiedenmann, Inga Bekes, Wolfgang Janni, Nikolaus de Gregorio, Amelie de Gregorio,
Keywords
Related Articles
- EP ID EP48645
- DOI 10.4274/jtgga.galenos.2018.2018.0083
- Views 299
- Downloads 0
Pregnancy of patients with idiopathic thrombocytopenic purpura: maternal and neonatal outcomes
Objective: Thrombocytopenia occurs in 7% of pregnant women. Along with other causes, idiopathic thrombocytopenic purpura (ITP), which is an autoimmune disease with autoantibodies causing platelet destruction, must be con...
Analysis of community-based studies related with knowledge, awareness, attitude, and behaviors towards HPV and HPV vaccine published in Turkey: A systematic review
Human papilloma virus (HPV) vaccine is a proven method for preventing HPV-related cancers and genital warts, especially preventing cervical cancer. It is aimed to systematically review and synthesize conclusions in detai...
In patients with advanced ovarian cancer, primary suboptimal surgery has better survival outcome than interval suboptimal surgery
Objective: It is known that optimal or complete cytoreduction is the most important factor in patients with advanced ovarian cancer. The aim of this study was to examine the results of patients who did not undergo optima...
Post-partum tubal ligation at time of cesarean delivery or via laparoscopy as an interval sterilization has similar effects on ovarian reserve
Objective: To observe and compare the effect of postpartum tubal ligation (TL) procedures on ovarian reserve at women desiring TL as a contraceptive method at the end of pregnancy. Material and Methods: Eighty-one women...
Influence of evening/night-time birth on maternal/perinatal outcomes in a low-risk population
Objective: To compare maternal and perinatal outcomes between day-time and evening/night-time births in a low-risk population. Material and Methods: The present study had a retrospective and cross-sectional design. The...