Incidence of uterine sarcomas among patients operated for uterine fibroids by myomectomy and hysterectomy

Uterine fibroids are a common indication for hysterectomy or myomectomy. Even with optimal preoperative imaging, unexpected uterine sarcoma can be detected in histopathology after uterine fibroid surgery. In case of inadvertent morcellation of an unexpected uterine sarcoma the clinical outcomes, due to the rapid intraperitoneal dissemination of malignant tissue during the procedure can be negatively influenced.

The purpose of this study was to determine the prevalence of uterine sarcoma in women undergoing hysterectomy or myomectomy for benign uterine fibroids. We performed retrospective study (2003 – 2014 years). The total number of women operated for uterine fibroids was 2297. Of this, 938 (42.5%) women had myomectomies and 1269 (57.5%) women had hysterectomies. In myomectomies the most frequently used surgical method was laparoscopic myomectomy in 591 (63%) cases, followed by hysteroscopy myomectomy in 306 (32.62%) cases, and laparotomic myomectomy only in 41 (4.37%) cases. In hysterectomies, laparoscopic approaches significantly dominated in 1163 (61.1%) cases, showing laparotomic approaches in 491 (25.82%) cases and vaginal approaches in 247 (12.99%) cases. Only, one patient with endometrial stromal sarcoma (ESS) was not preoperatively diagnosed and treated as symptomatic uterine fibroid; this patient underwent laparoscopic supracervical hysterectomy. In the post-operative histopathological examination ESS was detected. Thus, our incidence of sarcomas among women who underwent benign uterine fibroid surgery is 1/2297 (0,043%).

Laparoscopic power morcellation should be performed only in cases with no suspicious of malignancy. Patients, who undergo laparoscopic surgery with power morcellation should be informed about the possible risks of morcellation in cases of rare not suspected malignant disease.