Role of surgery in gynaecological sarcomas

Abstract

Gynaecological sarcomas account for 3-4% of all gynaecological malignancies and have a poorer prognosis compared to gynaecological carcinomas. Pivotal treatment for early-stage uterine sarcoma is represented by total hysterectomy. Whereas oophorectomy provides survival advantage in endometrial stromal sarcoma is still controversial. When the disease is confined to the uterus, systematic pelvic and para-aortic lymphadenectomy is not recommended. Removal of enlarged lymph-nodes is indicated in case of disseminated or recurrent disease, where debulking surgery is considered the standard of care. Fertility sparing surgery for uterine leiomyosarcoma is not supported by strong evidence, whilst available data on fertility sparing treatment for endometrial stromal sarcoma are more promising. For ovarian sarcomas, in the absence of specific data, it is reasonable to adapt recommendations existing for uterine sarcomas, also regarding the role of lymphadenectomy in both early and advanced stage disease. Specific recommendations on cervical sarcomas' surgery are lacking. Existing data on surgical approach vary from radical hysterectomy to fertility-preserving surgery in the form of trachelectomy or wide local excision, however no definite conclusions can be drafted on the recommended surgical approach. For vulval sarcomas, complete surgical excision with at least 2 cm of free margin is considered to be the primary treatment which is associated with good prognosis. The aim of this review is to provide highest quality evidence to guide gynaecologic oncologists throughout surgical management of gynaecological sarcomas.

Diagnosis, treatment and survival of uterine sarcoma: A retrospective cohort study of 122 cases

“…Uterine sarcomas are a group of rare neoplasms, arising from myometrial or mesenchymal tissue, which represent 3 to 7% of uterine cancer and tend to affect more elderly women, to exhibit aggressive behavior with fast-growing, early distant metastasis and diagnosed in more advanced stages (1)(2)(3). Surgery is considered the basis of the treatment and other treatment modalities, such as chemotherapy or radiation therapy, have shown limited results (3,4).…”

Endometrial stromal sarcoma: A review of rare mesenchymal uterine neoplasm

“…Techniques for safe specimen extraction, using insufflated isolation bags or transvaginal specimen retrieval via endoscopic bags, are now in progress and may represent a new use of morcellation in a laparoscopic approach. 49 There is no consensus regarding the role of adjuvant treatment. Chemotherapy has not proved effective for the treatment of LG-ESS as several studies have shown.…”

“…42,43,52 Surgery may have a role also in recurrent disease and radical cytoreduction seems to be associated with prolonged survival. 49 The role of hyperthermic intraperitoneal chemotherapy (HIPEC) in association with cytoreductive surgery has been investigated but further studies are needed to improve the use of this approach. A flow chart showing treatment strategy is present in Figure 2.…”

Assessing immune infiltration and the tumor microenvironment for the diagnosis and prognosis of sarcoma

“…Standard of care for patients with sarcoma is mainly comprised of local surgery, chemotherapy, and radiotherapy [12]. Among these, radical surgery or amputation is the most common [13]. Chemotherapy and radiotherapy are also included before and after surgery to prevent recurrence [14]; however, the success rate of treatment is currently low, and many patients still have poor prognoses and die of cancer-related causes.…”