Morcellation may worsen the outcome of occult uterine leiomyosarcoma (uLMS), while the effect of laparoscopic surgery itself, without morcellation, on the oncological outcomes of patients with early stage uLMS is also currently unknown. Materials and Methods: A retrospective analysis of 75 patients who underwent treatment for Stage I uLMS at Shanghai Cancer Center was performed. Kaplan-Meier and Cox proportional hazards regression models were used for analyses. Results: Fifty-five patients

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... went primary open surgery and 20 underwent laparoscopy. Patient age was significantly lower in the laparoscopy (44 ± 9.04 years) compared with the open surgery group (50.85 ± 9.96 years) (p < 0.007). Laparoscopic surgery was associated with shorter overall survival (OS) according to Kaplan-Meier (KM) log-rank test (p = 0.046), and multivariate Cox regression ([ = 0.032, RR = 2.423, 95% confidence interval, 1.081-5.429), but not disease-free survival (DFS) (p = 0.682, Kaplan--Meier log-rank test). In stratification analysis, patients who underwent laparoscopic total hysterectomy/modified radical hysterectomy (without morcellation ) had shorter DFS (p = 0.006) and OS (p = 0.001), compared with the open group. However, laparoscopic myomectomy and sub-total hysterectomy were associated with a similar DFS (p =0.924) and OS (p =0.580) to open total hysterectomy/modified radical hysterectomy. There was no significant difference in DFS (p = 0.941) or OS (p = 0.737) between laparoscopic surgery with and without morcellation. Conclusions: Laparoscopic surgery may be associated with poorer survival than open surgery in patients with early stage uLMS, even in the absence of morcellation.