nach oben

Erschienen in:

01.09.2015 | Review

Is open surgery the solution to avoid morcellation of uterine sarcomas? A systematic literature review on the effect of tumor morcellation and surgical techniques

verfasst von: Florian Ebner, Thomas W. P. Friedl, Christoph Scholz, Fabienne Schochter, Wolfgang Janni, Elena Vorwerk, Nikolaus deGregorio

Erschienen in: Archives of Gynecology and Obstetrics | Ausgabe 3/2015

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Today’s surgical standard of care for uterine leiomyomas is laparoscopic and/or vaginal surgery with larger specimens requiring morcellation to avoid open surgery. This is often associated with intra-abdominal dissemination of cellular material which in case of a uterine sarcoma might result in iatrogenic seeding of malignant tumor cells. The aim of this systematic literature review is to evaluate the surgical techniques and the impact of accidental tumor morcellation on the outcome of patients postoperatively diagnosed with malignant uterine sarcomas.

Methods

The National Library of Medicine database (pubmed) and Web of science were searched individually using three different search terms (‘morcel* sarcoma’, ‘survival, sarcoma, treatment, Uter*’, and ‘disease free survival, sarcoma, treatment, uter*’). After excluding duplicates and screening for relevance, 16 articles were left for full-text review, resulting in seven case series with more than 5 patients.

Results

The case numbers range from 14 to 123 patients with the majority of cases being leiomyosarcomas.

Conclusion

There is no reliable diagnostic tool to differentiate a fibroid from a uterine sarcoma preoperatively. Tumor morcellation occurs in various open and closed surgical techniques and is not limited to laparoscopic surgery only. There is an urgent need for a presurgical diagnostic parameter.

Hagemann IS, Hagemann AR, LiVolsi VA, Montone KT, Chu CS (2011) Risk of occult malignancy in morcellated hysterectomy: a case series. Int J Gynecol Pathol 30(5):476–483PubMedCrossRef

Leung F, Terzibachian J-J, Gay C, Chung Fat B, Aouar Z, Lassabe C et al (2009) Hysterectomies performed for presumed leiomyomas: should the fear of leiomyosarcoma make us apprehend non laparotomic surgical routes? Gynécol Obs Fertil 37(2):109–114CrossRef

Scholz C, Wöckel A, Ebner F, Reich A, Janni W (2012) Uteruserhaltende Myomchirurgie—SpringerMedizin. Gynakologe 11:841–846CrossRef

Gregorio N, Ebner F, Scholz C, Wöckel A, Janni W, Varga D (2014) Erkennen des Uterussarkoms: Eine vielleicht unterschätzte Gefahr. Der Gynäkologe 47(1):31–34. doi:10.1007/s00129-013-3202-2 CrossRef

Tropé CG, Abeler VM, Kristensen GB (2012) Trope diagnosis and treatment of sarcoma of the uterus a review. Acta Oncol (Stockholm, Sweden) 51:694–705CrossRef

Hendrickson M, Tavassoli F, Kempson R, McCluggage WG, Haller U, Kubik-Huch RA (2003) Mesenchymal tumors of the uterus and related lesions. In: Tavassoli F, Devilee P (eds) Pathology and genetics of tumours of the breast and female genital organs World Health Organization Classification of Tumours. IARC Press, Lyon, pp 233–249

Kosary CL (2007) Chapter 15: cancer of the Corpus Uteri. In: Ries LAG, Young JL, Keel GE, Eisner MP, Lin YD HM-J (eds) SEER Survival monograph: cancer survival among adults: US SEER program, 1988–2001, patient and tumor characteristics. NIH Pub. N., National Cancer Institute, SEER Program, Bethesda, pp 123–132

Thomakos N, Rodolakis A, Zagouri F, Zacharakis D, Sotiropoulou M, Akrivos N et al (2013) Serum CA 125, CA 15-3, CEA, and CA 19-9: a prognostic factor for uterine carcinosarcomas? Arch Gynecol Obstet 287(1):97–102PubMedCrossRef

Rha SE, Byun JY, Jung SE, Lee SL, Cho SM, Hwang SS et al (2003) CT and MRI of uterine sarcomas and their mimickers. AJR 181(5):1369–1374PubMedCrossRef

10.

Amant F, Coosemans A, Debiec-Rychter M, Timmerman D, Vergote I (2009) Clinical management of uterine sarcomas. Lancet Oncol 10(12):1188–1198PubMedCrossRef

11.

Goto A, Takeuchi S, Sugimura K, Maruo T (2002) Usefulness of Gd-DTPA contrast-enhanced dynamic MRI and serum determination of LDH and its isozymes in the differential diagnosis of leiomyosarcoma from degenerated leiomyoma of the uterus. Int J Gynecol Cancer 12(4):354–361PubMedCrossRef

12.

Thomassin-Naggara I, Dechoux S, Bonneau C, Morel A, Rouzier R, Carette M-F et al (2013) How to differentiate benign from malignant myometrial tumours using MR imaging. Eur Radiol 23(8):2306–2314PubMedCrossRef

13.

Gadducci A, Cosio S, Romanini A, Genazzani AR (2008) The management of patients with uterine sarcoma: a debated clinical challenge. Crit Rev Oncol Hematol 65(2):129–142PubMedCrossRef

14.

Nitta E, Kanenishi K, Itabashi N, Tanaka H, Hata T (2014) Real-time tissue elastography of uterine sarcoma. Arch Gynecol Obstet 289(2):463–465PubMedCrossRef

15.

Lundholm C, Forsgren C, Johansson ALV, Cnattingius S, Altman D (2009) Hysterectomy on benign indications in Sweden 1987–2003: a nationwide trend analysis. Acta Obstet Gynecol Scand 88(1):52–58PubMedCrossRef

16.

Pitter MC, Simmonds C, Seshadri-Kreaden U, Hubert HB (2014) The impact of different surgical modalities for hysterectomy on satisfaction and patient reported outcomes. Interact J Med Res 3:e11PubMedCentralPubMedCrossRef

17.

Wright JD, Tergas AI, Burke WM, Cui RR, Ananth CV, Chen L, Hershman D (2014) Uterine pathology in women undergoing minimally invasive hysterectomy using morcellation. JAMA 314(12):1253–1255CrossRef

18.

O’Hanlan KA, McCutcheon SP, McCutcheon JG (2011) Laparoscopic hysterectomy: impact of uterine size. J Minim Invasive Gynecol 18(1):85–91

19.

Sinha R, Sundaram M, Lakhotia S, Mahajan C, Manaktala G, Shah P (2009) Total laparoscopic hysterectomy for large uterus. J Gynecol Endosc Surg 1(1):34–39PubMedCentralPubMedCrossRef

20.

Bardens D, Solomayer E, Baum S, Radosa J, Gräber S, Rody A et al (2014) The impact of the body mass index (BMI) on laparoscopic hysterectomy for benign disease. Arch Gynecol Obstet 289(4):803–807PubMedCrossRef

21.

Malzoni M, Perniola G, Hannuna K, Iuele T, Fruscella ML, Basili R et al (2004) A review of 445 cases of laparoscopic hysterectomy: benefits and outcome. Clin Ter 155(1):9–12PubMed

22.

Elessawy M, Schollmeyer T, Mettler L, Jonat W, Schem C, von Hehn U et al (2014) The incidence of complications by hysterectomy for benign disease in correlation to an assumed preoperative score. Arch Gynecol Obstet. doi:10.1007/s00404-014-3594-9 PubMed

23.

Stine JE, Clarke-Pearson DL, Gehrig PA (2014) Uterine morcellation at the time of hysterectomy: techniques, risks, and recommendations. Obstet Gynecol Surv 69(7):415–425PubMedCrossRef

24.

Durnali A, Tokluoğlu S, Özdemir N, Inanç M, Alkiş N, Zengin N et al (2012) Prognostic factors and treatment outcomes in 93 patients with uterine sarcoma from 4 centers in Turkey. Asian Pac J Cancer Prev 13(5):1935–1941PubMedCrossRef

25.

Morice P, Rodriguez A, Rey A, Pautier P, Atallah D, Genestie C et al (2003) Prognostic value of initial surgical procedure for patients with uterine sarcoma: analysis of 123 patients. Eur J Gynaecol Oncol 24(3–4):237–240PubMed

26.

Feng W, Hua K, Malpica A, Zhou X, Baak JPA (2013) Stages I to II WHO 2003-defined low-grade endometrial stromal sarcoma: how much primary therapy is needed and how little is enough? Int J Gynecol Cancer 23(3):488–493PubMedCrossRef

27.

Serur E, Lakhi N (2013) Tips and tricks for successful manual morcellation: a response to “vaginal morcellation: a new strategy for large gynecological malignant tumor extraction”. Gynecol Oncol 128(1):150PubMedCrossRef

28.

Favero G (2013) Tips and tricks for successful manual morcellation: a response to “vaginal morcellation: a new strategy for large gynecological malignant tumors extraction. A pilot study”. Gynecol Oncol 128(1):151PubMedCrossRef

29.

Einstein MH, Barakat RR, Chi DS, Sonoda Y, Alektiar KM, Hensley ML et al (2008) Management of uterine malignancy found incidentally after supracervical hysterectomy or uterine morcellation for presumed benign disease. Int J Gynecol Cancer 18(5):1065–1070

30.

Perri T, Korach J, Sadetzki S, Oberman B, Fridman E, Ben-Baruch G (2009) Uterine leiomyosarcoma: does the primary surgical procedure matter? Int J Gynecol Cancer 19(2):257–260PubMedCrossRef

31.

Della Badia C, Karini H (2010) Endometrial stromal sarcoma diagnosed after uterine morcellation in laparoscopic supracervical hysterectomy. J Minim Invasive Gynecol 17(6):791–793

32.

Anupama R, Ahmad SZ, Kuriakose S, Vijaykumar DK, Pavithran K, Seethalekshmy NV (2011) Disseminated peritoneal leiomyosarcomas after laparoscopic “myomectomy” and morcellation. J Minim Invasive Gynecol 18(3):386–389

33.

Park J-Y, Kim D-Y, Kim J-H, Kim Y-M, Kim Y-T, Nam J-H (2011) The impact of tumor morcellation during surgery on the outcomes of patients with apparently early low-grade endometrial stromal sarcoma of the uterus. Ann Surg Oncol 18(12):3453–3461PubMedCrossRef

34.

Park J-Y, Park S-K, Kim D-Y, Kim J-H, Kim Y-M, Kim Y-T et al (2011) The impact of tumor morcellation during surgery on the prognosis of patients with apparently early uterine leiomyosarcoma. Gynecol Oncol 122(2):255–259PubMedCrossRef

35.

Leung F, Terzibachian J-J (2012) Re: “The impact of tumor morcellation during surgery on the prognosis of patients with apparently early uterine leiomyosarcoma”. Gynecol Oncol 124(1):172–173 (author reply 173)PubMedCrossRef

36.

Favero G, Anton C, Silva e Silva A, Ribeiro A, Araújo MP, Miglino G et al (2012) Vaginal morcellation: a new strategy for large gynecological malignant tumor extraction: a pilot study. Gynecol Oncol 126(3):443–447

37.

Seidman MA, Oduyebo T, Muto MG, Crum CP, Nucci MR, Quade BJ (2012) Peritoneal dissemination complicating morcellation of uterine mesenchymal neoplasms. PLoS One 11:e50058CrossRef

38.

Anaf V, Simon P, Govaerts I, Noël J-C, Rodesch F (2008) Pitfall of the LASH technique: an unsuspected leiomyosarcoma removed after morcellation. Gynaecol Endosc 257(1):47–49CrossRef

39.

George S, Barysauskas C, Serrano C, Oduyebo T, Rauh-Hain JA, Del Carmen MG et al (2014) Retrospective cohort study evaluating the impact of intraperitoneal morcellation on outcomes of localized uterine leiomyosarcoma. Cancer 15120(20):3154–3158CrossRef

40.

Bell SW, Kempson RL, Hendrickson MR (1994) Problematic uterine smooth muscle neoplasms. A clinicopathologic study of 213 cases. Am J Surg Pathol 18(6):535–558PubMedCrossRef

41.

Pautier P, Genestie C, Rey A, Morice P, Roche B, Lhommé C et al (2000) Analysis of clinicopathologic prognostic factors for 157 uterine sarcomas and evaluation of a grading score validated for soft tissue sarcoma. Cancer 1588(6):1425–1431CrossRef

42.

Oduyebo T, Rauh-Hain AJ, Meserve EE, Seidman MA, Hinchcliff E, George S et al (2014) The value of re-exploration in patients with inadvertently morcellated uterine sarcoma. Gynecol Oncol 132(2):360–365PubMedCrossRef

43.

Ricci S, Giuntoli RL, Eisenhauer E, Lopez MA, Krill L, Tanner EJ et al (2013) Does adjuvant chemotherapy improve survival for women with early-stage uterine leiomyosarcoma? Gynecol Oncol 131(3):629–633PubMedCrossRef

44.

Akers SN, Groman A, Odunsi K, Lele S, Frederick PJ (2013) Adjuvant treatment for uterine leiomyosarcoma. Eur J Gynaecol Oncol 34(5):409–414PubMed

45.

O’Cearbhaill R, Hensley ML (2010) Optimal management of uterine leiomyosarcoma. Expert Rev Anticancer Ther 10(2):153–169PubMedCrossRef

46.

Rothmund R, Hartkopf A, Joachim C, Walter CB, Wallwiener M, Kraemer B et al (2014) Clinical characteristics, pathological reevaluation, surgical management and adjuvant therapy of patients with endometrial stromal tumors. Arch Gynecol Obstet 290(6):1195–1200PubMedCrossRef

47.

Bernard B, Clarke BA, Malowany JI, McAlpine J, Lee C-H, Atenafu EG et al (2013) Uterine adenosarcomas: a dual-institution update on staging, prognosis and survival. Gynecol Oncol 131(3):634–639PubMedCrossRef

48.

Tanner EJ, Toussaint T, Leitao MM, Hensley ML, Soslow RA, Gardner GJ et al (2013) Management of uterine adenosarcomas with and without sarcomatous overgrowth. Gynecol Oncol 129(1):140–144PubMedCrossRef

49.

Brower V(2014) FDA considers restricting or banning laparoscopic morcellation. J Natl Cancer Inst 106(10). doi:10.1093/jnci/dju339

50.

Callister M, Ramondetta LM, Jhingran A, Burke TW, Eifel PJ (2004) Malignant mixed Müllerian tumors of the uterus: analysis of patterns of failure, prognostic factors, and treatment outcome. Int J Radiat Oncol Biol Phys 158(3):786–796CrossRef

51.

Chan JK, Kawar NM, Shin JY, Osann K, Chen L-M, Powell CB et al (2008) Endometrial stromal sarcoma: a population-based analysis. Br J Cancer 2199(8):1210–1215CrossRef

52.

Shah SH, Jagannathan JP, Krajewski K, O’Regan KN, George S, Ramaiya NH (2012) Uterine sarcomas: then and now. AJR Am Roentgen Ray Soc 23199(1):213–223

53.

Kim J-A, Lee MS, Choi J-S. Sonographic findings of uterine endometrial stromal sarcoma. Korean J Radiol 7(4):281–286

54.

Schwartz LB, Diamond MP, Schwartz PE (1993) Leiomyosarcomas: clinical presentation. Am J Obstet Gynecol 168(1 Pt 1):180–183PubMedCrossRef

55.

Bonneau C, Thomassin-Naggara I, Dechoux S, Cortez A, Darai E, Rouzier R (2014) Value of ultrasonography and magnetic resonance imaging for the characterization of uterine mesenchymal tumors. Acta Obstet Gynecol Scand 93(3):261–268PubMedCrossRef

56.

Tamai K, Koyama T, Saga T, Morisawa N, Fujimoto K, Mikami Y et al (2008) The utility of diffusion-weighted MR imaging for differentiating uterine sarcomas from benign leiomyomas. Eur Radiol 18(4):723–730PubMedCrossRef

57.

Zhao Z, Yoshida Y, Kurokawa T, Kiyono Y, Mori T, Okazawa H (2013) 18F-FES and 18F-FDG PET for differential diagnosis and quantitative evaluation of mesenchymal uterine tumors: correlation with immunohistochemical analysis. J Nucl Med 54(4):499–506PubMedCrossRef

58.

Kitajima K, Murakami K, Kaji Y, Sugimura K (2010) Spectrum of FDG PET/CT findings of uterine tumors. AJR 195(3):737–743PubMedCrossRef

59.

Yamane T, Takaoka A, Kita M, Imai Y, Senda M (2012) 18F-FLT PET performs better than 18F-FDG PET in differentiating malignant uterine corpus tumors from benign leiomyoma. Ann Nucl Med 26(6):478–484PubMedCrossRef

60.

Kao YH, Saad U, Tan AEH, Magsombol BM, Padhy AK (2011) Fluorine-18-fluorodeoxyglucose PET/CT for the evaluation of suspected recurrent uterine leiomyosarcomas. Acta Radiol 152(4):463–466CrossRef

Titel: Is open surgery the solution to avoid morcellation of uterine sarcomas? A systematic literature review on the effect of tumor morcellation and surgical techniques
verfasst von: Florian Ebner
Thomas W. P. Friedl
Christoph Scholz
Fabienne Schochter
Wolfgang Janni
Elena Vorwerk
Nikolaus deGregorio
Publikationsdatum: 01.09.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: Archives of Gynecology and Obstetrics / Ausgabe 3/2015
Print ISSN: 0932-0067
Elektronische ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-015-3664-7

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Die Highlights vom Kongress des American College of Cardiology 2024

Springer Medizin

Is open surgery the solution to avoid morcellation of uterine sarcomas? A systematic literature review on the effect of tumor morcellation and surgical techniques