Kerry Graebe1, Arlene Garcia-Soto2, Michael Aziz1, Vanessa Valarezo1, Paul B Heller3, Nana Tchabo3, Daniel H Tobias3, Charbel Salamon4, Joseph Ramieri1, Craig Dise5, Brian M Slomovitz6. 1. Atlantic Health System, Department of Obstetrics, Gynecology, and Women's Health, Morristown, NJ, United States. 2. Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami, FL, United States. 3. Atlantic Health System, Division of Gynecologic Oncology, Carol G. Simon Cancer Center, Morristown, NJ, United States. 4. Atlantic Health System, Division of Pelvic Floor and Reconstructive Surgery, Morristown, NJ, United States. 5. Atlantic Health System, Department of Pathology, Morristown, NJ, United States. 6. Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami, FL, United States. Electronic address: bxs255@med.miami.edu.
Abstract
OBJECTIVE: Uterine fibroids often require hysterectomy via a laparotomy or utilizing minimally invasive surgical (MIS) approach. Morcellation is a fragmentation of the uterus into smaller pieces. The objective of this study is to determine the incidence of malignancies found in morcellated specimens at our institution. METHODS: Women who had a minimally invasive hysterectomy, for presumptive benign uterine conditions were identified, included and reviewed. Patients were divided into two groups being either benign disease or malignancies. The continuous variables uterine weight and patient age were tested for normalcy with the Shapiro-Wilk test. The exposure of subspecialist vs general gynecology was interrogated via a Chi-Squared analysis. RESULTS: 10 cases of malignancies were identified including endometrioid endometrial carcinomas (3), uterine serous carcinoma (1), endometrial stromal sarcomas (ESS) (3), and leiomyosarcomas (LMS) (3). An overall risk of occult cancer on a morcellated specimen was .73%; leiomyosarcoma was 0.22%, endometrial stromal sarcoma 0.22%, and endometrial cancer 0.29%. The median uterine weight for the 10 morcellated malignancies was 293.5g whereas the median weight for the benign uteri was only 117.5g giving a theta of -106 (95% CI -261,20). There was no difference in patient age or surgeon type between the groups (See Table 1). CONCLUSIONS: Morcellation was associated with substantially higher risk of abdominopelvic recurrence and lower disease-free survival. Morcellated uterine malignancies were significantly heavier than benign uteri. Further research on uterine morcellation should focus on decision and cost-benefit analyses to determine the ideal candidate in whom uterine morcellation during minimally invasive hysterectomy would facilitate more good than harm.
OBJECTIVE: Uterine fibroids often require hysterectomy via a laparotomy or utilizing minimally invasive surgical (MIS) approach. Morcellation is a fragmentation of the uterus into smaller pieces. The objective of this study is to determine the incidence of malignancies found in morcellated specimens at our institution. METHODS:Women who had a minimally invasive hysterectomy, for presumptive benign uterine conditions were identified, included and reviewed. Patients were divided into two groups being either benign disease or malignancies. The continuous variables uterine weight and patient age were tested for normalcy with the Shapiro-Wilk test. The exposure of subspecialist vs general gynecology was interrogated via a Chi-Squared analysis. RESULTS: 10 cases of malignancies were identified including endometrioid endometrial carcinomas (3), uterine serous carcinoma (1), endometrial stromal sarcomas (ESS) (3), and leiomyosarcomas (LMS) (3). An overall risk of occult cancer on a morcellated specimen was .73%; leiomyosarcoma was 0.22%, endometrial stromal sarcoma 0.22%, and endometrial cancer 0.29%. The median uterine weight for the 10 morcellated malignancies was 293.5g whereas the median weight for the benign uteri was only 117.5g giving a theta of -106 (95% CI -261,20). There was no difference in patient age or surgeon type between the groups (See Table 1). CONCLUSIONS: Morcellation was associated with substantially higher risk of abdominopelvic recurrence and lower disease-free survival. Morcellated uterine malignancies were significantly heavier than benign uteri. Further research on uterine morcellation should focus on decision and cost-benefit analyses to determine the ideal candidate in whom uterine morcellation during minimally invasive hysterectomy would facilitate more good than harm.
Authors: Garri Tchartchian; Bernd Bojahr; Sven Becker; Attilio Di Spiezio Sardo; Vasilis Tanos; Hugo C Verhoeven; Markus Wallwiener; Rudy L De Wilde Journal: J Obstet Gynaecol India Date: 2018-12-04
Authors: Young Bin Won; Hyun Jin Lee; Kyung Jin Eoh; Young Shin Chung; Yong Jae Lee; Seon Hee Park; Jee Whan Kim; Jung Yoon Lee; Eun Ji Nam; Sunghoon Kim; Young Tae Kim; Sang Wun Kim Journal: Obstet Gynecol Sci Date: 2018-02-02
Authors: S Cabrera; V Bebia; U Acosta; S Franco-Camps; L Mañalich; A García-Jiménez; A Gil-Moreno Journal: Clin Transl Oncol Date: 2020-11-18 Impact factor: 3.405