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Home E-Weekly February 24, 2015

Are Morcellation Fears Overblown?

Published: February 23, 2015

The spread of unrecognized cancer during minimally invasive gynecological surgery has occurred in very few women, according to a pair of new studies, which may allay at least some fears about power morcellation's potential risks to patient health.

In November 2014, the FDA issued a warning about the use of power morcellators during fibroid surgery, stating that the devices may spread unsuspected cancer and decrease patients' long-term survival rates.

But a study published in Obstetrics and Gynecology showed a very low incidence of uterine sarcoma among hysterectomy patients. University of Michigan researchers had reviewed 7,499 cases — mostly undertaken for benign reasons — to find that the 2.7% of unexpected gynecologic cancers included only 0.22% were uterine sarcoma. Women with sarcoma were more likely to have a history of venous thromboembolism and pre-op blood transfusions, notes the study.

"We found that there is a risk of unexpected cancer discovery at the time of a hysterectomy for what was presumed to be for a benign or non-cancerous indication, however, the risk is fairly small," says senior author Sawsan As-Sanie, MD, MPH, an assistant professor of obstetrics and gynecology at Michigan.

Dr. As-Sanie says caution is still warranted when planning hysterectomies, but a minimally invasive approach can't be automatically avoided for many women. "Physicians need to balance optimizing technologies that have well-known patient-centered benefits while still being cognizant of the rare but true risk of undiagnosed cancer," she adds.

Another study, published in JAMA Oncology, showed uterine cancer appeared in 0.19% of nearly 40,0000 women who underwent myomectomy without power morecellation and in 0.09% of the approximately 3,000 women who had the procedure performed with power morecellation. Notably, incidence of pathologic abnormalities increased with age.

"Given that older women are at the greatest risk for pathologic abnormalities, electric power morcellation should be approached with caution in patients older than 50 years undergoing myomectomy," the authors write.

Daniel Cook

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