Fertility Sparing in Uterine Sarcomas: Single Center Experience of 13 Patients

Abstract

Purpose of Investigation: The feasibility and safety of conservative surgery is not well defined for fertility sparing approach for uterine sarcoma due to very low incidence and poor prognosis. The authors present their experience regarding fertility preservation for uterine sarcoma. Materials and Methods: A total of 13 patients with uterine sarcoma were included in this retrospective case study; endometrial stromal sarcoma (ESS) (n=6) and leiomyosarcoma (LMS) (n=7). Patients data, including clinicopathological characteristics and prognostic information were extracted from medical records. Excision of mass and reconstruction of uterus was performed for fertility sparing in all patients and staging surgery (bilateral pelvic and para-aortic lymphadenectomy +/- omentectomy) as performed for five cases (one ESS case and four LMS cases). Results: The median size of the mass was 8.5 (range: 1-22) cm. Median follow-up time was 54 (range 13-142) months. Recurrence rate was 69.2% (9/13). The mean relapse interval was 30.69 months. Four patients died and all of them was diagnosed with LMS. Four pregnancies (37%) were recorded. Two of them occurred with assisted reproductive technologies (intracytoplasmic sperm injection), the other two pregnancies were spontaneous, and all of them had a cesarean delivery. Conclusion: Patients should be informed about prognosis of uterine sarcomas and risk of fertility preserving approach. Close follow-up is obligatory and complementary surgery should be performed after completion of fertility due to high recurrence rate and poor prognosis especially with LMS.