Impact of morcellation on survival outcomes of patients with unexpected uterine leiomyosarcoma

a systematic review and meta-analysis

Giorgio Bogani, William Arthur Cliby, Giovanni D. Aletti

Research output: Contribution to journalArticle

79 Citations (Scopus)

Abstract

OBJECTIVE: To review the current evidence on the effects of intra-abdominal morcellation on survival outcomes of patients affected by unexpected uterine leiomyosarcoma (ULMS) and to estimate the risk of recurrence in those patients.

METHODS: PubMed (MEDLINE), Scopus, Embase, Web of Science databases as well as ClinicalTrails.gov, were searched for data evaluating the effects of intra-abdominal morcellation on survival outcomes of patients with undiagnosed ULMS. Studies were evaluated per the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) and the American College of Obstetricians and Gynecologists (ACOG) guidelines.

RESULTS: Sixty manuscripts were screened, 11 (18%) were selected and four (7%) were included. Overall, 202 patients were included: 75 (37%) patients had morcellation of ULMS, while 127 (63%) patients had not. A meta-analysis of these studies showed that morcellation increased the overall (62% vs. 39%; OR: 3.16 (95% CI: 1.38, 7.26)) and intra-abdominal (39% vs. 9%; OR: 4.11 (95% CI: 1.92, 8.81)) recurrence rates as well as death rate (48% vs. 29%; OR: 2.42 (95% CI: 1.19, 4.92)). No between-group difference in cumulative extra-abdominal recurrence (OR: 0.34 (95% CI: 0.07, 1.59)) rate was observed.

CONCLUSIONS: Our data support a significant correlation between uterine morcellation and an increased risk of intra-abdominal recurrence in patients affected by unexpected ULMS. However, the limited data on this issue and the absence of high level of evidence suggest the need of further studies designed to estimate the risk to benefit ratio of morcellation in patients with uterine fibroids and undiagnosed ULMS.

Original languageEnglish (US)
Pages (from-to)167-172
Number of pages6
JournalGynecologic Oncology
Volume137
Issue number1
DOIs
StatePublished - Apr 1 2015

Fingerprint

Leiomyosarcoma
Meta-Analysis
Survival
Recurrence
Manuscripts
Morcellation
Leiomyoma
PubMed
MEDLINE
Databases
Guidelines
Mortality

Keywords

  • Leiomyosarcoma
  • Morcellation
  • Power morcellator
  • Recurrence
  • Uterine sarcoma

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Impact of morcellation on survival outcomes of patients with unexpected uterine leiomyosarcoma : a systematic review and meta-analysis. / Bogani, Giorgio; Cliby, William Arthur; Aletti, Giovanni D.

In: Gynecologic Oncology, Vol. 137, No. 1, 01.04.2015, p. 167-172.

Research output: Contribution to journalArticle

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title = "Impact of morcellation on survival outcomes of patients with unexpected uterine leiomyosarcoma: a systematic review and meta-analysis",
abstract = "OBJECTIVE: To review the current evidence on the effects of intra-abdominal morcellation on survival outcomes of patients affected by unexpected uterine leiomyosarcoma (ULMS) and to estimate the risk of recurrence in those patients.METHODS: PubMed (MEDLINE), Scopus, Embase, Web of Science databases as well as ClinicalTrails.gov, were searched for data evaluating the effects of intra-abdominal morcellation on survival outcomes of patients with undiagnosed ULMS. Studies were evaluated per the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) and the American College of Obstetricians and Gynecologists (ACOG) guidelines.RESULTS: Sixty manuscripts were screened, 11 (18{\%}) were selected and four (7{\%}) were included. Overall, 202 patients were included: 75 (37{\%}) patients had morcellation of ULMS, while 127 (63{\%}) patients had not. A meta-analysis of these studies showed that morcellation increased the overall (62{\%} vs. 39{\%}; OR: 3.16 (95{\%} CI: 1.38, 7.26)) and intra-abdominal (39{\%} vs. 9{\%}; OR: 4.11 (95{\%} CI: 1.92, 8.81)) recurrence rates as well as death rate (48{\%} vs. 29{\%}; OR: 2.42 (95{\%} CI: 1.19, 4.92)). No between-group difference in cumulative extra-abdominal recurrence (OR: 0.34 (95{\%} CI: 0.07, 1.59)) rate was observed.CONCLUSIONS: Our data support a significant correlation between uterine morcellation and an increased risk of intra-abdominal recurrence in patients affected by unexpected ULMS. However, the limited data on this issue and the absence of high level of evidence suggest the need of further studies designed to estimate the risk to benefit ratio of morcellation in patients with uterine fibroids and undiagnosed ULMS.",
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N2 - OBJECTIVE: To review the current evidence on the effects of intra-abdominal morcellation on survival outcomes of patients affected by unexpected uterine leiomyosarcoma (ULMS) and to estimate the risk of recurrence in those patients.METHODS: PubMed (MEDLINE), Scopus, Embase, Web of Science databases as well as ClinicalTrails.gov, were searched for data evaluating the effects of intra-abdominal morcellation on survival outcomes of patients with undiagnosed ULMS. Studies were evaluated per the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) and the American College of Obstetricians and Gynecologists (ACOG) guidelines.RESULTS: Sixty manuscripts were screened, 11 (18%) were selected and four (7%) were included. Overall, 202 patients were included: 75 (37%) patients had morcellation of ULMS, while 127 (63%) patients had not. A meta-analysis of these studies showed that morcellation increased the overall (62% vs. 39%; OR: 3.16 (95% CI: 1.38, 7.26)) and intra-abdominal (39% vs. 9%; OR: 4.11 (95% CI: 1.92, 8.81)) recurrence rates as well as death rate (48% vs. 29%; OR: 2.42 (95% CI: 1.19, 4.92)). No between-group difference in cumulative extra-abdominal recurrence (OR: 0.34 (95% CI: 0.07, 1.59)) rate was observed.CONCLUSIONS: Our data support a significant correlation between uterine morcellation and an increased risk of intra-abdominal recurrence in patients affected by unexpected ULMS. However, the limited data on this issue and the absence of high level of evidence suggest the need of further studies designed to estimate the risk to benefit ratio of morcellation in patients with uterine fibroids and undiagnosed ULMS.

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