Occult Malignancy Rate of 1498 Hysterectomies or Myomectomies with Morcellation: A Retrospective Single-Arm Study
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Background and Purpose
Since April 2014, the FDA warns against the use of morcellation during minimally invasive uterine surgery because of the risk of occult malignant spreading in the abdominal cavity. It is clear, however, that more studies are needed to define the incidence of occult uterine cancers, its risk factors, preoperative identification and postoperative follow-up. The present retrospective single-arm study defines the prevalence of occult uterine malignancies in a large group of patients treated with hysterectomy or myomectomy for benign indications.
In the year of 2014, 1498 women admitted for a myomectomy or hysterectomy in benign conditions at the clinic of minimally invasive surgery (Minimal Invasive Chirurgie or MIC) in Berlin (Germany) were included in this study. The morcellated uterine specimens of operated patients were histologically analyzed for the presence of cancerous tissue.
We detected malignancies in three of the 1498 women (0.2%): two patients had endometrial cancer, while we observed cervical cancer in situ in the third patient. No sarcoma was found.
We detected a very low prevalence of occult uterine malignancy which is in line with several other recent studies. To define a clear policy on the use of morcellation, more studies are required. In the meantime, patients should be informed about the risks of morcellation in case of undetected cancer prior to surgery.
KeywordsMorcellation Laparoscopy Hysterectomy Myomectomy Malignancy
Compliance with Ethical Standards
Conflict of interest
Garri Tchartchian, Bernd Bojahr, Sven Becker, Attilio Di Spiezio Sardo, Vasilis Tanos, Hugo Christian Verhoeven, Markus Wallwiener, Rudy L De Wilde declare that they have no conflict of interest.
For the present retrospective study, no ethical approval is required in Germany. Prof. Dr. Rudy L De Wilde, head of the University Clinic of Gynecology in Oldenburg, Germany, approved and supervised the present study from conception through manuscript submission.
Retrospectively, we selected our patient group based on matching inclusion and exclusion criteria, and we contacted each of those patients to obtain informed consent before the inclusion of their data in this study.
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