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.
Muñoz‐Casares et al. (Mon,) studied this question.
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