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Incidence of unexpected uterine malignancies after electromechanical power morcellation: a retrospective multicenter analysis in Germany

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

During the last decade, electromechanical power morcellation (EMM) was more frequently used but it may be associated with the dissemination of occult malignancies. The aim of the present study was to determine the frequency of unexpected uterine malignancies after EMM.

Methods

This retrospective study consisted of patients who were treated at three departments of Gynecology in Germany from 2008 to 2017. We identified women who underwent an operation with the use of EMM. Clinical records, risk factors, and the outcomes of the patients were reviewed.

Results

We performed an analysis of 1683 patients who had undergone laparoscopic supracervical hysterectomy (LASH), total hysterectomy, or myomectomy (LM) (48.6%, 8.4%, and 43.0%, respectively). Unexpected malignancies were detected in 4 of 1683 patients (0.24%). In all cases, the malignancy proved to be a sarcoma and was detected after LASH. All patients with occult sarcomas were older than 45 years and the most common (75%) risk factor was the appearance of a solitary tumor. The patients underwent secondary laparotomy for complete oncological staging, and no histological dissemination of the sarcoma was registered. Two patients had a recurrence. At the final follow-up investigation all four patients were in good general health.

Conclusion

Occult malignancies are liable to spread after EMM, although the overall risk of being diagnosed with an occult malignancy and the risk of dissemination appear to be low. Once the preoperative diagnostic investigation has yielded no suspicious findings, laparoscopic morcellation may be considered a safe method, especially LM in patients of reproductive age.

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Data availability

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

None. All contributors meet the criteria for authorship. There was no further contribution. Authors’ information: All authors read and approved the final manuscript. Submission: The work described has not been published before. It is not under consideration for publication anywhere else.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, Haus A, 23538, Luebeck, Germany

    G. Gitas, A. Rody & S. Baum

  2. Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany

    I. Alkatout, L. Mettler & K. Abdusattarova

  3. Department of Obstetrics and Gynecology, Municipal Hospital of Leverkusen, Leverkusen, Germany

    A. K. Ertan

  4. First Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloníki, Greece

    G. Pados

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  1. G. Gitas
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  3. L. Mettler
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  4. K. Abdusattarova
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  8. S. Baum
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Contributions

Protocol/project development: GG, AI. Data collection or management: GG, AI, ML, EAK, BS. Data analysis: GG, AI, AK, RA, PG, BS. Manuscript writing/editing: GG, AI.

Corresponding author

Correspondence to G. Gitas.

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The authors declare that they have no competing interests.

Ethical approval

Approval was obtained from the Ethics Committee of the Medical Faculty of the University of Luebeck (Approval number: 18-115). Patient consent was also obtained. The report has been performed in accordance with the Declaration of Helsinki.

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Patient consent was obtained.

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Gitas, G., Alkatout, I., Mettler, L. et al. Incidence of unexpected uterine malignancies after electromechanical power morcellation: a retrospective multicenter analysis in Germany. Arch Gynecol Obstet 302, 447–453 (2020). https://doi.org/10.1007/s00404-020-05620-4

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  • DOI: https://doi.org/10.1007/s00404-020-05620-4

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