Is Adnexectomy Mandatory at the Time of Hysterectomy for Uterine Sarcomas? A Systematic Review and Meta-Analysis

Carlo Ronsini; Aniello Foresta; Matteo Giudice; Antonella Reino; Marco La Verde; Luigi Della Corte; Giuseppe Bifulco; Pasquale de Franciscis; Stefano Cianci; Vito Andrea Capozzi

doi:10.3390/medicina58091140

Is Adnexectomy Mandatory at the Time of Hysterectomy for Uterine Sarcomas? A Systematic Review and Meta-Analysis

Medicina (Kaunas). 2022 Aug 23;58(9):1140. doi: 10.3390/medicina58091140.

Affiliations

¹ Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
² Department of Woman and Child Sciences, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy.
³ Department of Neuroscience, Reproductive Sciences, and Dentistry, University of Naples Federico II, 80138 Naples, Italy.
⁴ Department of Obstetrics and Gynecology, University of Messina, 98122 Messina, Italy.
⁵ Department of Medicine and Surgery, University Hospital of Parma, 43125 Parma, Italy.

Abstract

Background and Objectives: Uterine sarcomas represents only 3% of all the female genital tract ones. The tumoral stage is the most significant prognostic factor. The role of the bilateral salpingo-oophorectomy (BSO) in the surgical management of FIGO stage IA and IB appears still controversial. This review aims to investigate the impact of bilateral adnexectomy in the treatment of uterine sarcoma. Methods: Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we systematically searched the PubMed, Scopus, Cochrane, Medline, and Medscape databases in February 2022. We applied no language or geographical restrictions, but we considered only English studies. We included the studies containing data about Recurrence Rate (RR), Disease-free Survival (DFS), and Overall Survival (OS). We used comparative studies for meta-analysis. Results: Seventeen studies fulfilled the inclusion criteria; 2 retrospective observational studies, and 15 retrospective comparative studies, And 14 out of the 15 comparative studies were enrolled in meta-analysis. A total of 3743 patients were analyzed concerning the use of adnexectomy with hysterectomy in patients with uterine sarcoma and compared with those who did not. Meta-analysis highlighted a non-significant worsening of the OS in the BSO group compared to the OP group and showed that adnexectomy does not improve the DFS (BSO OR 1.23 (95% CI 0.81-1.85) p = 0.34; I² = 24% p = 0.22). Conclusions: Most studies selected for our review showed that adnexectomy does not significantly affect the RR, OS, and PFS in treating FIGO stage I uterine sarcomas. Therefore, even if there is a unanimous consensus about bilateral adnexectomy in menopausal patients, preservation of ovarian tissue may be considered in premenopausal women. Nonetheless, there are not enough cases in the literature to recommend this procedure.

Keywords: bilateral salpingo-oophorectomy; endometrial stromal sarcoma; uterine adenosarcoma; uterine leiomyosarcoma; uterine stromal sarcoma.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Female
Humans
Hysterectomy / methods
Neoplasm Staging
Retrospective Studies
Sarcoma* / surgery
Uterine Neoplasms* / pathology

Grants and funding

This research received no external funding.