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Leiomyosarcoma And Power Morcellators

Risk of Unexpected Sarcoma Discovery After Hysterectomy Appears Low

Written by Jeff Meyer on 27 Apr 2015

According to a new large-scale study by the University of Michigan departments of Obstetrics and Gynecology finds uterine sarcome, a potentially aggressive type of cancer that forms in tissues in the uterus, was found in 0.22 % of women following a hysterectomy for benign conditions.

Research in February’s issue of Obstetrics and Gynecology, says it may have found implications for the risks associated with morcellation, a minimally invasive procedure that cuts large tissue inside the body into smaller pieces so it can be removed through smaller incisions.

New guidelines on power morcellators, an electrical device that is used by surgeons to help with morcellation, have recently been issued by the FDA, after concerns that the machine could possibly be spreading unsuspected tumors throughout the body, appearing as benign fibroids.

Assistant Professor in the Department of Obstetrics and Gynecology at the University of Michigan Medical School, senior author Sawsan As-Sanie, M.D., M.P.H, says, “We found that there is a risk of unexpected cancer discovery at the time of a hysterectomy for what was presumed to be for a benign or non-cancerous indication, however, the risk is fairly small.” She continued, “Caution is warranted in preoperative planning for a hysterectomy, but for a significant number of women, a minimally-invasive procedure may still be a very viable and beneficial option. Physicians need to balance optimizing technologies that have well-known patient-centered benefits while still being cognizant of the rare but true risk of undiagnosed cancer.”

Researchers analyzed 2013 data from a quality and safety database maintained by the Michigan Surgical Quality Collaborative, a statewide group of hospitals that voluntarily reports surgical outcomes. The study included 6,360 women who underwent a hysterectomy for benign conditions such as pelvic pain, fibroids, endometriosis or abnormal uterine bleeding. The study concluded that a total 2.7 percent incidence of unexpected cancer in women who had a hysterectomy for benign indications, but the majority of cases – 1.02 percent – were unexpected endometrial cancer. However, only .22% of hysterectomies performed for benign indications contained uterine sarcoma.

The risks correlated with power morcellation has received heavy attention in the media lately, and have been mainly linked to sarcomas, since there are no available methods to accurately decipher sarcomas from otherwise benign uterine fibroids before surgery. The study also found that there were no reliable clinical predictors of uterine sarcoma before surgery.

“The ultimate goal in the field is to eventually find more reliable ways to accurately distinguish between benign fibroids and uterine sarcomas,” As-Sanie says. “For now, this data confirms a very low incidence of unexpected uterine sarcoma and is valuable information to inform patients and physicians when considering treatment options for fibroid-related symptoms. Our focus is on minimizing risks without taking choices with potentially better outcomes away from patients that are at low risk of an undiagnosed cancer.”


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