Incidental power morcellation of malignancy: A retrospective cohort study

Kerry Graebe, Arlene E Garcia-Soto, Michael Aziz, Vanessa Valarezo, Paul B. Heller, Nana Tchabo, Daniel H. Tobias, Charbel Salamon, Joseph Ramieri, Craig Dise, Brian Slomovitz

Research output: Contribution to journalArticle

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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 293.5 g whereas the median weight for the benign uteri was only 117.5 g 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.

Original languageEnglish (US)
Pages (from-to)274-277
Number of pages4
JournalGynecologic Oncology
Volume136
Issue number2
DOIs
StatePublished - Feb 1 2015

Fingerprint

Cohort Studies
Retrospective Studies
Endometrial Stromal Sarcoma
Hysterectomy
Uterus
Neoplasms
Leiomyosarcoma
Endometrial Neoplasms
Weights and Measures
Endometrioid Carcinoma
Leiomyoma
Gynecology
Laparotomy
Disease-Free Survival
Cost-Benefit Analysis
Morcellation
Carcinoma
Recurrence
Incidence
Research

Keywords

  • Malignancy
  • Minimally-invasive
  • Morcellation
  • Sarcoma

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology
  • Medicine(all)

Cite this

Graebe, K., Garcia-Soto, A. E., Aziz, M., Valarezo, V., Heller, P. B., Tchabo, N., ... Slomovitz, B. (2015). Incidental power morcellation of malignancy: A retrospective cohort study. Gynecologic Oncology, 136(2), 274-277. https://doi.org/10.1016/j.ygyno.2014.11.018

Incidental power morcellation of malignancy : A retrospective cohort study. / Graebe, Kerry; Garcia-Soto, Arlene E; Aziz, Michael; Valarezo, Vanessa; Heller, Paul B.; Tchabo, Nana; Tobias, Daniel H.; Salamon, Charbel; Ramieri, Joseph; Dise, Craig; Slomovitz, Brian.

In: Gynecologic Oncology, Vol. 136, No. 2, 01.02.2015, p. 274-277.

Research output: Contribution to journalArticle

Graebe, K, Garcia-Soto, AE, Aziz, M, Valarezo, V, Heller, PB, Tchabo, N, Tobias, DH, Salamon, C, Ramieri, J, Dise, C & Slomovitz, B 2015, 'Incidental power morcellation of malignancy: A retrospective cohort study', Gynecologic Oncology, vol. 136, no. 2, pp. 274-277. https://doi.org/10.1016/j.ygyno.2014.11.018
Graebe K, Garcia-Soto AE, Aziz M, Valarezo V, Heller PB, Tchabo N et al. Incidental power morcellation of malignancy: A retrospective cohort study. Gynecologic Oncology. 2015 Feb 1;136(2):274-277. https://doi.org/10.1016/j.ygyno.2014.11.018
Graebe, Kerry ; Garcia-Soto, Arlene E ; Aziz, Michael ; Valarezo, Vanessa ; Heller, Paul B. ; Tchabo, Nana ; Tobias, Daniel H. ; Salamon, Charbel ; Ramieri, Joseph ; Dise, Craig ; Slomovitz, Brian. / Incidental power morcellation of malignancy : A retrospective cohort study. In: Gynecologic Oncology. 2015 ; Vol. 136, No. 2. pp. 274-277.
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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 293.5 g whereas the median weight for the benign uteri was only 117.5 g 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.",
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AU - Heller, Paul B.

AU - Tchabo, Nana

AU - Tobias, Daniel H.

AU - Salamon, Charbel

AU - Ramieri, Joseph

AU - Dise, Craig

AU - Slomovitz, Brian

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N2 - 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 293.5 g whereas the median weight for the benign uteri was only 117.5 g 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.

AB - 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 293.5 g whereas the median weight for the benign uteri was only 117.5 g 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.

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KW - Minimally-invasive

KW - Morcellation

KW - Sarcoma

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