| Title: |
Surgical Management and Therapeutic Strategy of Uterine Sarcoma According to Histological Subtype and Staging: Updated Review and Recommendations. |
| Authors: |
Muñoz-Casares, Francisco Cristóbal; Gómez-Barbadillo, José; Álvarez-Álvarez, Rosa; Hindi, Nadia; Sebio, Ana; Lozano-Lominchar, Pablo; Fernández-Hernández, Juan Ángel; Vasques, Hugo; Muñoz-Muñoz, Paula; Asencio-Pascual, José Manuel |
| Source: |
Cancers; Jun2026, Vol. 18 Issue 12, p1870, 28p |
| Subject Terms: |
Uterine tumors; Hysterectomy; Sarcoma; Salpingo-oophorectomy; Cancer relapse; Radiotherapy; Leiomyosarcoma; Immunotherapy; Tumor grading; Treatment effectiveness; Endometrial tumors; Adjuvant chemotherapy; Combined modality therapy; Conceptual structures; Hormone therapy; Tumor classification; Individualized medicine; Fertility preservation; Health care teams; Symptoms |
| Abstract: |
Simple Summary: Uterine sarcomas are characterized by their rarity, biological aggressiveness, and high locoregional recurrence rates, showing poor response to conventional treatments and, consequently, dismal survival outcomes. Similar to other soft tissue sarcomas, initial surgery is a key factor in the prognosis of these patients. However, in most cases, patients receive incomplete or suboptimal surgery due to misdiagnosis at initial presentation. We present an updated review of the different histological subtypes of uterine sarcoma and the appropriate therapeutic strategy for each—specifically regarding individualized surgical procedures according to accurate tumor staging—with the aim of establishing clear and concise recommendations to improve the management and expectations of this malignant disease. Background: Uterine sarcomas represent a small and heterogeneous subgroup of uterine malignancies (accounting for less than 5%), characterized by high biological aggressiveness, high recurrence rates, and diagnostic complexity; surgical management remains the cornerstone of treatment and, consequently, the primary determinant of patient prognosis. Objective: This review synthesizes current evidence regarding the accurate diagnosis and appropriate surgical management of the main histological subtypes of uterine sarcoma across different stages, within a multidisciplinary therapeutic framework. Methods: A comprehensive narrative review was conducted using recent publications from major biomedical databases, with an emphasis on studies exploring surgical outcomes, molecular profiling, therapeutic strategies, and survival patterns. Results: Leiomyosarcoma and endometrial stromal sarcoma represent more than 80% of histological subtypes, with histological grade being the factor of greatest prognostic significance. Complete disease resection, without tumor fragmentation and with negative surgical margins, is the undisputed standard objective. Variations from the standard treatment—en bloc total hysterectomy with bilateral salpingo-oophorectomy—exist depending on histology and tumor staging. Conclusions: Individualized surgical treatment tailored to the specific histological subtype, combined with multimodal treatment strategies based on accurate tumor staging, molecular characterization, and recurrence patterns, is essential to improve survival. Such management should be conducted in referral centers with expertise in treating these rare and fearsome malignancies. [ABSTRACT FROM AUTHOR] |
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| Database: |
Complementary Index |