Uterine sarcomas remain challenging tumours to manage and need multi-disciplinary care. This article reviews the surgical and adjuvant treatments for these tumours. The importance of surgical staging is discussed and the need for careful review of the pathology. Newer classifications will help to distinguish the different types as we now recognise that carcinosarcomas are most likely to be epithelial cancers rather then sarcomas. A critical discussion of the roles of both adjuvant chemotherapy and radiation are discussed. Some recent important trials have helped to give better evidence base on which to plan future treatment strategies. The routine place of adjuvant pelvic radiation seems limited as it only leads to improved local control. To date chemotherapy studies have equally failed to show a benefit. More trials are needed to address these issues. We cannot be complacent as we still see too high a relapse rate and new treatment approaches are required, investigation of the new targeted agents may offer a more promising return. Given their relative uncommonness, centralisation of care and discussion at multi-disciplinary tumour boards is essential. International collaboration is essential.