Uterine cancer low in myomectomy with power morcellation

Key clinical point: Among women who underwent myomectomy, the prevalence of cancers was low but increased with age.

Major finding: Rates of uterine cancers for women who underwent myomectomy with and without electric power morcellation were 0.09% and 0.19%, respectively.

Data source: The nationwide database study retrospectively analyzed 41,777 women who underwent myomectomy in 496 U.S. hospitals.

Disclosures: The researchers reported having no financial disclosures.

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Moving toward reliable surgical quality metrics

Most systematic literature reviews and large studies have focused on hysterectomy patients, overlooking myomectomy patients, according to a commentary by Dr. Ceana Nezhat. Worldwide, thousands of myomectomies are performed in reproductive-age women to preserve and enhance fertility. The impact of tissue disruption at the time of myomectomy by any method carries a small risk of intraperitoneal dissemination of occult malignant tissue. Studies on the prevalence of malignant and premalignant uterine lesions in younger patients are needed to better understand the risks tumor dissemination during myomectomy by any method, he wrote.

“The FDA black box warning on power morcellators must not cause a reversal to laparotomy or increase in the number of hysterectomies for uterine tumors,” Dr. Nezhat wrote.

“The report by Wright et al. opens the door to the use of administrative data. However, there are significant differences between administrative data and clinical registries to measure outcome and surgical quality,” Dr. Nezhat wrote. An earlier report based on clinical data found that electric power morcellation was associated with substantially higher risk of abdominopelvic recurrence and lower disease-free survival than suggested by the Wright study, he wrote.

Using administrative data is much less expensive than maintaining prospective registries. Developing strategies to combine clinical data, including final pathology reports and long-term results, with administrative data will help in improving surgical quality, as well as aid in counseling patients based on scientific research, according to Dr. Nezhat.

Dr. Ceana Nezhat is a minimally invasive surgeon at the Atlanta Center for Minimally Invasive Surgery and Reproductive Medicine. These remarks were part of an editorial accompanying the report (JAMA Oncol. 2015 Feb. 19). Dr. Nezhat is a consultant for Karl Storz Endoscopy, a medical adviser to Plasma Surgical, and serves on the Scientific Advisory Board of SurgiQuest.




The prevalence of uterine cancer was 0.09% among women who underwent myomectomy with electric power morcellation, according to the results of a large database study, lower than for women who underwent myomectomy without power morcellation.

But the prevalence of uterine cancer increased with age, the researchers reported on Feb. 19 in JAMA Oncology.

Dr. Jason D. Wright
Dr. Jason D. Wright

“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,” Dr. Jason D. Wright and his colleagues at Columbia University, New York, wrote (JAMA Oncol. 2015 Feb.19).

Electric power morcellation facilitates the excision of uterine leiomyoma in minimally invasive surgery. Its use has received increased scrutiny after a patient underwent hysterectomy with electric power morcellation for presumed benign leiomyoma that was, in fact, a uterine sarcoma, which was disseminated. The case has prompted an evaluation of electric power morcellation safety in performance of hysterectomy and myomectomy.

The Food and Drug Administration also entered the debate last year, issuing a safety alert for electric power morcellators in November and warning “against the use of laparoscopic power morcellators in the majority of women undergoing myomectomy or hysterectomy for treatment of fibroids.”

The Columbia University researchers examined the prevalence of cancers and precancerous abnormalities of the uterus in women who underwent myomectomy from 2006 to 2012 using administrative data from the Perspective database.

Among 38,557 women who underwent myomectomy without electric power morcellation, uterine cancer prevalence was 0.19% or 1 in 528, and prevalence of any pathologic abnormality was 0.67% or 1 in 150.

For women who underwent the procedure with electric power morcellation, uterine cancer prevalence was 0.09% or 1 in 1,073, and prevalence of any pathologic abnormality was 0.43% or 1 in 230.

Age was the strongest risk factor for uterine cancer and other abnormalities.

Comparing women aged 50-59 years to women 60 years and older who had myomectomy without morcellation, the prevalence of uterine cancer increased from 0.62% to 3.40%. In women who had power morcellation, the prevalence of uterine cancer was 0.97% in women aged 50-59 years and 0% in those 60 years or older.

The researchers reported similar trends for endometrial hyperplasia and overall adverse pathologic findings.

The researchers reported having no financial disclosures.

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