The postoperative recurrence rate of mesenchymal sarcoma, i.e. endometrial mesenchymal sarcoma, is related to the degree of malignancy, and the higher the degree of malignancy, the higher the recurrence rate. Endometrial mesenchymal sarcoma can be categorized into low-risk malignancy and high-risk malignancy, and total hysterectomy should be considered as the first step in treatment. Compared with other types of uterine sarcoma, mesenchymal sarcoma has a relatively good prognosis, and the postoperative recurrence rate will be relatively low in the case of low-risk malignant mesenchymal sarcoma. However, in the case of undifferentiated uterine sarcoma, the malignancy is high and the prognosis is poor, and it is very likely to recur. In the case of recurrence, we recommend subtractive surgery and hormonal therapy. Endometrial mesenchymal sarcoma requires active medical treatment to prolong the survival time. If left untreated, it is prone to metastasis.