Incidental power morcellation of malignancy

A retrospective cohort study

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

Research output: Contribution to journalArticle

42 Citations (Scopus)

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
Externally publishedYes

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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

All Science Journal Classification (ASJC) codes

  • Oncology
  • Obstetrics and Gynecology

Cite this

Graebe, Kerry ; Garcia-Soto, Arlene ; Aziz, Michael ; Valarezo, Vanessa ; Heller, Paul ; Tchabo, Nana ; Tobias, Daniel ; Salamon, Charbel ; Ramieri, Joseph ; Dise, Craig ; Slomovitz, Brian M. / 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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Graebe, K, Garcia-Soto, A, Aziz, M, Valarezo, V, Heller, P, Tchabo, N, Tobias, D, Salamon, C, Ramieri, J, Dise, C & Slomovitz, BM 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

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

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

Research output: Contribution to journalArticle

TY - JOUR

T1 - Incidental power morcellation of malignancy

T2 - A retrospective cohort study

AU - Graebe, Kerry

AU - Garcia-Soto, Arlene

AU - Aziz, Michael

AU - Valarezo, Vanessa

AU - Heller, Paul

AU - Tchabo, Nana

AU - Tobias, Daniel

AU - Salamon, Charbel

AU - Ramieri, Joseph

AU - Dise, Craig

AU - Slomovitz, Brian M.

PY - 2015/2/1

Y1 - 2015/2/1

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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