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LiFE re

Literature for ENYGO

Uterine sarcoma (treatment and follow-up)

Editor Marcin Bobiński Controversies around the FDA’s report initiated an open letter
addressed to this institution, in which it was suggested that the FDA
Descriptive summary guidance was based on misleading analysis and should be reconsid-
ered [9]. The review by Bogani et al., concluding that intra-abdominal
The incidence of occult uterine sarcoma morcellation should be banned from clinical practice [10], adds to
this debate.
Many retrospective studies, published in the period covered by the
third LiFE report, discussed the incidence of unsuspected malignant Preoperative diagnostics of myometrial lesions
disease at the time of myomectomy (MM) or total hysterectomy (TH)
for benign indications. The problem of missing specific and sensitive enough methods to
differentiate benign and malignant tumours is widely discussed by
K ho et al. estimated that occult uterine sarcoma (US) occurs in several authors:
0.089 % (1 of 1,124 TH) [1].
C ho et al. identified following preoperative risk factors that might
P icerno et al. estimated the incidence of malignancy to be 0.2 % be useful for discrimination of US and leiomyoma of the uterus:
(1 of 502), all cases were endometrial cancers; no cases of US [2]. Neutrofil-to-lymphocyte ratio (>2.1), tumour size (>8cm), body
mass index (BMI <=20) [11].
R aine-Bennett et al. found the incidence of US to be 1 of 278 or
3.60 (95 % confidence interval [CI] 2.97-4.23) and leiomyosarcoma L in et al. presented data on the diagnostic accuracy of con-
(LMS) 1 of 429 or 2.33 (95 % CI 1.83-2.84) per 1,000 total hyster- trast-enhanced MRI and diffusion-weighted magnetic resonance
ectomies [3]. imaging (DW MRI) in differentiation between uterine lesions.
They reported (based on a relatively small group of patients) that
In the research by Paul et al. the incidence of US was found to be CE MRI can provide accurate information regarding preoperative
0.29 % (1 in 335 patients) [4]. diagnosis (accuracy=0.94, sensitivity=0.88, specificity=0.96) and
seems to be a superior method to DW MRI [12].
R odriguez et al. assessed the incidence of US to be 12.9 per
10,000 for patients younger than 49 [5]. Treatment

Sarcoma patients’ outcome after morcellation The role of gemcitabine-based chemotherapy in sarcomas is
discussed by Ducoulombier et al. in their systemic review, but they
G ao et al. retrospectively analysed 59 patients who underwent conclude that further research in this field is strongly recommended
fibroid morcellation (FM) without specimen retrieval bags or TH [13]. Ducie et al. highlighted the advances in adjuvant therapy in
and had a postoperative diagnosis of US: LMS over the last 5 years [14].

- Only pathological grade level was a significant risk factor affect- For treatment with bevacizumab therapy in patients with recurrent
ing recurrence free survival (RFS) and overall survival (OS) sarcoma, please see “Medical treatment of recurrent endometrial
cancer” by E. Surynt.
- The 5-year RFS and OS rates were both lower in the FM vs. the
TH group, FM was not the statistically significant risk factor
affecting RFS and OS [6].

H arris et al. analysed 18,299 patients and compared various meth-
ods of TH and postoperative outcome before and after the Food
and Drug Administration (FDA) warning. They reported:

- Increased rate of abdominal and vaginal, decreased rate of
laparoscopic TH (p=0.025, <0.01, <0.01; respectively)

- Increased incidence of major postoperative complications and
readmissions [7].

M andato et al. confirmed these findings in their survey conducted
among Italian gynaecologists [8].

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International Journal of Gynecological Cancer, Volume 26, Supplement #1 Page 31