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ObjectivesTo evaluate the impact of preoperative diagnosis of malignancy on survival in patients surgically treated for apparent early-stage uterine leiomyosarcoma (ULMS).MethodsData of consecutive patients who underwent total hysterectomy at Del Ponte Hospital, (Varese-Italy) between January 2000 and December 2019 were retrieved. Only cases with histologically proven ULMS at final diagnosis were included and stratified according with the preoperative finding of malignancy into: ‘Suspicious ULMS’ vs. ‘unexpected ULMS’. Demographic, pathologic and surgical-related characteristics were compared. Survivals curves were estimated with Kaplan-Meier methods and predictors of recurrence were investigated.ResultsOverall 36 patients ULMS were included, 24 and 12 ‘unexpected ULMS’ and ‘suspicious ULMS’, respectively. No significant differences between the groups in terms of baseline characteristics and surgical approach (minimally-invasive approach: 3, 25% vs. 15, 62.5%, p=0.08) were found. The morcellation of the uterus was less likely performed in patients in ‘suspicious ULMS’ (18, 33% vs.14, 58.33%; p=0.005). The survival analysis did not show statistical differences between the groups. No differences in survival (DFS (log-rank=0.28) and OS (log-rank=0.78).Details on recurrence are reported (table 1). No predictors of relapse were found, including uterine morcellation (41.67% vs. 66.67%, p=0.15).Abstract EPV141/#627 Table 1ConclusionsPatients undergoing hysterectomy for ULMS have poor prognosis regardless the surgical approach. In our population, preoperative suspicious of malignancy did not influence survival outcomes and morcellation did not seem to have a detrimental effect on recurrence rate.Larger studies are warranted to confirm our findings.

ObjectivesTo evaluate the rate of lymphatic-related morbidity among patients undergoing surgical staging for apparent early-stage ovarian cancer (EOC) and to report the specific patients’ lymphatic complications.MethodsData of consecutive patients who underwent surgical staging for EOC between 01/2002 and 12/2018 were analyzed. A self-reported validated 13-item lymphedema screening questionnaire was sent to evaluate specific lymphatic complications. Patients were stratified by the performance retroperitoneal staging into two groups: fully pelvic and aortic lymphadenectomy performed (LND) vs. no retroperitoneal staging (NO-LND). Patients who had conservative treatment were included in the study. The analysis focused only on women who answered the specific questionnaire. Patients lost at follow-up and those who reported peripheral vascular disease at the time of surgery were excluded.ResultsDuring the study period 140 patients were treated; according to the inclusion/exclusion criteria 107 represented our study population. Baseline characteristics such as age, BMI, Charlson Comorbidity Index (CCI) and surgical approach did not significantly differ between the groups. Patients in LND group (compared to NO-LND) had a higher rate of specific lymphatic complications (26.6% vs. 0%, p <0.01). The performance of lymphadenectomy significantly impacted the subjective lymphatic-related morbidity (score >5).Abstract EPV219/#581 Table 1ConclusionsOur study confirms a high correlation between the performance of LND and specific lymphatic morbidity in patients undergoing surgical staging for EOC. The dedicated 13-item screening questionnaire might be a useful tool to categorize patients’ perception of lymphatic-related complications, including lower extremity lymphedema.

ObjectivesTo estimate the incidence and to identify risk factors of leiomyosarcoma among women undergoing hysterectomy for presumed benign disease.MethodsThis is a retrospective single-center study of consecutive patients who underwent total hysterectomy with benign indications at Del Ponte Hospital (Varese) between 01/01/2000 and 31/12/2019. Data were manually collected by operative records and institutional surgical reports, including demographic and histopathologic characteristics. Factors associated with the occurrence of unexpected uterine leiomyosarcoma (uLMS) were searched. Stratification by age, menopausal status and uterine weight was performed.ResultsOverall, 4428 patients were included in the analysis and 24 (0,54%) had a final diagnosis of uLMS. Among 2936 patients with preoperative indication of uterine fibroids, the rate of uLMS was 0,99%. The increase of age at surgery resulted to be positively associated with the incidence of uLMS (from 0.09% in patients <45yo to 1.97% in patients >75yo; p=0.01). The absolute risk of LMS increased in post- vs. premenopausal patients (1.27% vs. 0.25%; p=0.001). Increase in uterine weight was also associated with higher risk of uLMS (p<0.001).The pooled analysis included menopausal status (pre vs. post) and uterine weight (<1 kg vs. >1 kg); post-menopausal women with uterus weighting 1kg or more had an absolute risk of uLMS of 5.45%.Abstract EPV123/#437 Table 1Abstract EPV123/#437 Table 2ConclusionsThe overall risk of uLMS in women undergoing hysterectomy for presumed benign indication is low. However, there is a significant increased risk in post-menopausal patients with enlarged uteri.

Questo contributo si configura come un dialogo, articolato fra osservazioni, domande e risposte. Nasce dall’intento di dare voce ad alcune professionalità che da vari anni interagiscono con il Settore Bronzi e Armi antiche, sia per collaborazioni che per seminari organizzati all’interno dell’attività didattica della Scuola di Alta Formazione dell’Opificio delle Pietre Dure.