Reoperation with Total Hysterectomy after Incomplete Surgery Is Helpful in Patients with Incidentally Diagnosed Uterine Leiomyosarcoma

Abstract

<b><i>Objective:</i></b> The aim of this study was to evaluate the impact of initial surgical treatments and surgical re-exploration on the oncological outcomes of patients with incidentally diagnosed uterine leiomyosarcoma (uLMS). <b><i>Design:</i></b> A retrospective analysis of 87 patients who underwent re-exploration for incidentally diagnosed uLMS at the Fudan University Shanghai Cancer Center was performed. <b><i>Methods:</i></b> Kaplan-Meier and Cox proportional hazards regression models were used for analyses. <b><i>Results:</i></b> The median age (range) at diagnosis was 49 (23–76) years. The median disease-free survival (DFS) and overall survival (OS) were 15.1 and 56.7 months, respectively. The Kaplan-Meier curves and log-rank tests showed the median DFS was longer in patients with restaging operation (<i>N</i> = 30) than without (<i>N</i> = 55) (<i>p</i> = 0.017) but no significant difference in median OS (<i>p</i> = 0.142). In patients who underwent myomectomy/subtotal hysterectomy, 5 patients (28.5%) had remnant sarcoma during re-exploration with complete uterine removal, and re-exploration was associated with longer DFS (<i>p</i> = 0.038) and OS (<i>p</i> = 0.042). <b><i>Limitations:</i></b> The limitation of this study is its retrospective observational design with a limited number of patients. <b><i>Conclusion:</i></b> Reoperation with total hysterectomy after incomplete surgery may be helpful in patients with incidentally diagnosed uLMS at the first treatment.