Uterine Sarcomas: Pre- and Intra-operative Considerations

Abstract

Uterine leiomyomas are the most common indication for hysterectomy and myomectomy. Compared with the laparoscopic approach, the abdominal approach for hysterectomy is associated with a higher risk of a venous thromboembolic event, blood transfusion, prolonged hospital stays, wound pain, and infection. Unfortunately, some women with uterine mass undergoing surgery had unexpected uterine sarcomas. Spreading an unexpected uterine sarcoma during a hysterectomy or myomectomy can worsen the prognosis. Thus, a pre-operative diagnosis of uterine sarcomas is relatively challenging. Obstetrician-gynecologists should pre-operatively discuss the possibility of malignancy of the disease, risk, and benefit of the operative approach with the patient with a uterine mass. In this article, we reviewed the concerns of uterine sarcomas in patients with a uterine mass in terms of the disease incidence, pathological and clinical features, pre-operative evaluation tools such as biomarkers and imaging, intra-operative gross evaluation, and the roles of the intra-operative tissue containment system.