Morcellation worsens survival outcomes in patients with undiagnosed uterine leiomyosarcomas: A retrospective MITO group study Francesco Raspagliesi, M.D. a , Giuseppa Maltese, M.D. a , Giorgio Bogani, M.D., Ph.D. a , Giovanni Fucà, M.D. b , Stefano Lepori, M.D. a , Pierandrea De Iaco, M.D. c , Myriam Perrone, M.D. c , Giovanni Scambia, M.D. d , Gennaro Cormio, M.D. e,f , Stefano Bogliolo, M.D. g , Alice Bergamini, M.D. h , Giuseppe Bifulco, M.D. i , Paolo Giovanni Casali, M.D. b , Domenica Lorusso, M.D., Ph.D. a, ⁎ a Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Gynecologic Oncology, Milan, Italy b Fondazione IRCCS Istituto Nazionale dei Tumori, Department of Medical Oncology, Milan, Italy c University of Bologna, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, S. Orsola Hospital, Bologna, Italy d Catholic University of The Sacred Heart, Division of Gynecologic Oncology, Rome, Italy e Oncology Institute “Giovanni Paolo II”, Bari, Italy f University of Bari, Gynecologic Oncology Unit, Bari, Italy g IRCCS Fondazione Policlinico San Matteo, University of Pavia, Department of Obstetrics and Gynecology, Pavia, Italy h San Raffaele Hospital, Department of Obstetrics and Gynecology, Milan, Italy i University of Naples “Federico II”, Department of Neuroscience and Reproductive and Odontostomatologic Science, Naples, Italy HIGHLIGHTS • Morcellation worsens survival of patients affected by uterine leiomyosarcomas. • Effects of morcellation on STUMP and ESS need to be further evaluated. • The role of morcellation of apparent benign fibroids deserves further investigations. abstract article info Article history: Received 21 September 2016 Received in revised form 26 October 2016 Accepted 1 November 2016 Available online xxxx Objective. To investigate the impact of morcellation on survival outcomes of patients affected by undiagnosed uterine sarcoma. Methods. This is a retrospective study performed in 8 referral centers of MITO group. Data of women under- going morcellation for apparent benign uterine myomas who were ultimately diagnosed with stage I uterine sar- coma on final pathology were compared with data of women who did not undergo morcellation. Uterine sarcoma included: leiomyosarcomas (LMS), smooth muscle tumors of uncertain malignant potential (STUMP), low-grade endometrial stromal sarcomas (LG-ESS) and undifferentiated uterine sarcomas (UUS). Two-year sur- vival outcomes were evaluated using Kaplan-Meir and Cox models. Results. Overall 125 patients were identified: 31(24.8%), 21(16.8%) and 73(58.4%) patients had power morcellation during laparoscopy, non power morcellation during open surgery and non morcellation during open procedures, respectively. Considering patients affected by LMS, morcellation did not correlated with dis- ease-free survival. However, patients undergoing either morcellation or power morcellation experienced a 3- fold increase risk of death in comparison to patients who had not morcellation (p = 0.02). A trend towards an increase of recurrence was observed for patients undergoing morcellation for STUMP (HR 7.7, p = 0.09); while no differences in survival outcomes were observed for patients with LG-ESS and UUS. Conclusions. Our data suggest that morcellation increase the risk of death in patients affected by undiagnosed LMS. Further prospective studies are warranted in order to assess the risk to benefit ratio of power morcellator utilization in patients with apparent benign uterine myomas. © 2016 Published by Elsevier Inc. Keywords: Morcellation Survival Laparoscopy Myoma Sarcoma 1. Introduction Uterine leiomyosarcoma represents a rare entity, constituting about 1.5% of all uterine malignancies, with an estimated annual incidence of Gynecologic Oncology xxx (2016) xxx–xxx ⁎ Corresponding author at: Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy. E-mail address: domenica.lorusso@istitutotumori.mi.it (D. Lorusso). YGYNO-976517; No. of pages: 6; 4C: http://dx.doi.org/10.1016/j.ygyno.2016.11.002 0090-8258/© 2016 Published by Elsevier Inc. Contents lists available at ScienceDirect Gynecologic Oncology journal homepage: www.elsevier.com/locate/ygyno Please cite this article as: F. Raspagliesi, et al., Morcellation worsens survival outcomes in patients with undiagnosed uterine leiomyosarcomas: A retrospective MITO group study, Gynecol Oncol (2016), http://dx.doi.org/10.1016/j.ygyno.2016.11.002