Megan Wasson1, Paul Magtibay2, Paul Magtibay2, Javier Magrina2. 1. Department of Gynecologic Surgery, Mayo Clinic Arizona, Phoenix, Arizona. Electronic address: wasson.megan@mayo.edu. 2. Department of Gynecologic Surgery, Mayo Clinic Arizona, Phoenix, Arizona.
Abstract
STUDY OBJECTIVE: To determine the incidence and impact of occult uterine malignancy following vaginal hysterectomy and uncontained morcellation. DESIGN: An Institutional Review Board-approved retrospective cohort study (Canadian Task Force classification II-2). SETTING: Three academic medical centers. PATIENTS: All women who underwent vaginal hysterectomy between January 1, 2008, and August 31, 2015, at 3 institutions were considered for inclusion in the study. INTERVENTIONS: Total vaginal hysterectomy with and without morcellation. MEASUREMENTS AND MAIN RESULTS: A total of 2296 women underwent total vaginal hysterectomy without (n = 1685) or with (n = 611) vaginal morcellation performed via cold-knife wedge resection. All patients requiring morcellation had benign indications for hysterectomy. The incidence of occult uterine malignancy among hysterectomies requiring vaginal morcellation was 0.82% (n = 5) and included stage IA, grade I endometrial adenocarcinoma (n = 3; 0.49%) and low grade stromal sarcoma (n = 2; 0.33%). Demographic data for those with occult malignancy included mean age 48.8 years, mean body mass index 32.36 kg/m2, and median parity 2. Indication for hysterectomy was abnormal uterine bleeding for the 5 patients who underwent morcellation and were found to have a malignancy. Final pathology revealed a mean uterine weight of 231.60 g. All patients have remained disease-free, and no deaths have occurred. Mean disease-free survival was 48.33 months (range, 33-67 months) for the patients with endometrial adenocarcinoma and 42.0 months (range, 19-65 months) for the patients with stromal sarcoma for the 5 patients who underwent vaginal hysterectomy with morcellation. CONCLUSION: Among patients undergoing vaginal hysterectomy with morcellation, the incidence of occult uterine carcinoma is 0.82%. Uncontained vaginal morcellation when used concomitantly with vaginal hysterectomy does not appear to negatively impact patient prognosis or outcomes.
STUDY OBJECTIVE: To determine the incidence and impact of occult uterine malignancy following vaginal hysterectomy and uncontained morcellation. DESIGN: An Institutional Review Board-approved retrospective cohort study (Canadian Task Force classification II-2). SETTING: Three academic medical centers. PATIENTS: All women who underwent vaginal hysterectomy between January 1, 2008, and August 31, 2015, at 3 institutions were considered for inclusion in the study. INTERVENTIONS: Total vaginal hysterectomy with and without morcellation. MEASUREMENTS AND MAIN RESULTS: A total of 2296 women underwent total vaginal hysterectomy without (n = 1685) or with (n = 611) vaginal morcellation performed via cold-knife wedge resection. All patients requiring morcellation had benign indications for hysterectomy. The incidence of occult uterine malignancy among hysterectomies requiring vaginal morcellation was 0.82% (n = 5) and included stage IA, grade I endometrial adenocarcinoma (n = 3; 0.49%) and low grade stromal sarcoma (n = 2; 0.33%). Demographic data for those with occult malignancy included mean age 48.8 years, mean body mass index 32.36 kg/m2, and median parity 2. Indication for hysterectomy was abnormal uterine bleeding for the 5 patients who underwent morcellation and were found to have a malignancy. Final pathology revealed a mean uterine weight of 231.60 g. All patients have remained disease-free, and no deaths have occurred. Mean disease-free survival was 48.33 months (range, 33-67 months) for the patients with endometrial adenocarcinoma and 42.0 months (range, 19-65 months) for the patients with stromal sarcoma for the 5 patients who underwent vaginal hysterectomy with morcellation. CONCLUSION: Among patients undergoing vaginal hysterectomy with morcellation, the incidence of occult uterine carcinoma is 0.82%. Uncontained vaginal morcellation when used concomitantly with vaginal hysterectomy does not appear to negatively impact patient prognosis or outcomes.
Authors: Dominik Denschlag; Sven Ackermann; Marco Johannes Battista; Wolfgang Cremer; Gerlinde Egerer; Markus Follmann; Heidemarie Haas; Philipp Harter; Simone Hettmer; Lars-Christian Horn; Ingolf Juhasz-Boess; Karin Kast; Günter Köhler; Thomas Kröncke; Katja Lindel; Peter Mallmann; Regine Meyer-Steinacker; Alexander Mustea; Edgar Petru; Peter Reichardt; Dietmar Schmidt; Hans-Georg Strauss; Clemens Tempfer; Falk Thiel; Uwe Ulrich; Thomas Vogl; Dirk Vordermark; Paul Gass; Matthias W Beckmann Journal: Geburtshilfe Frauenheilkd Date: 2019-10-22 Impact factor: 2.915