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Cancer prevalence low in women who undergo myomectomy with electric power morcellation
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The prevalence of cancer and precancer abnormalities in the uterus was low among women who underwent myomectomy with electric power morcellation, according to retrospective study results.
However, the risk for cancer increased with age, results showed.
A determination of cancer prevalence in this group can help researchers identify the risk for the potential spread of malignancies with morcellators.
Jason D. Wright
“After the controversy surrounding electric power morcellation, most of the data that has been presented has examined use of the devices for hysterectomy,” Jason D. Wright, MD, division chief of gynecologic oncology at Columbia University Medical Center, told HemOnc Today. “However, electric power morcellators are also commonly used for myomectomy, a procedure where only the fibroids are removed from the uterus. We examined pathologic outcomes in women who underwent myomectomy with electric power morcellation.”
Wright and colleagues retrospectively evaluated data from 41,777 women who underwent myomectomy — the excision of uterine leiomyoma — at one of 496 hospitals between 2006 and 2012. Most of the women (61.7%) were aged younger than 40 years (61.7%).
Researchers determined 3,220 (7.7%) of the women underwent myomectomy with electric power morcellation. The utilization of electric power morcellation increased yearly, from 2.6% of cases in 2006 to 14% in 2012 (P ˂ .001).
Researchers identified uterine cancer in 76 women. The prevalence of uterine cancer in the cohort who did not undergo morcellation was 0.19% (95% CI, 0.15-0.23), whereas the prevalence in the morcellation cohort was 0.09% (95% CI, 0.02-0.27).
The prevalence of any pathologic finding — which included cancer, tumors of uncertain malignant potential or endometrial hyperplasia — was 0.67% (95% CI, 0.59-0.75) among those who did not undergo morcellation and 0.43% (95% CI, 0.21-0.66) among those who did undergo morcellation.
The risk for any pathological finding with or without morcellation increased with age. The prevalence ratio for uterine cancer — when compared with women aged younger than 40 years — increased from 3.19 (95% CI, 1.5-6.8) among women aged 40 to 49 years to 54.33 (95% CI, 23.5-125.48) among women aged older than 60 years.
“We found that the incidence of cancer was low — only 1 in 1,073 women,” Wright said. “This risk of cancer is much lower than the risk associated with the devices when used for hysterectomy. Older age was the strongest risk factor for cancer.”
The fact that Wright and colleagues evaluated administrative data may have affected the results, Ceana Nezhat, MD, of the Atlanta Center for Minimally Invasive Surgery and Reproductive Medicine, wrote in an invited commentary.
“Comparison between administrative data and clinical registries conducted for predicting surgical results revealed significant differences in both recording and outcomes,” Nezhat wrote. “Creating and maintaining a prospective registry is prohibitively costly and time consuming compared with gathering administrative data, which is inexpensive and readily available electronically. However, clinical data such as final pathology reports and long-term results supplemented with reliable administrative data is ideal for surgical quality improvement. Developing strategies to optimize data collection and gathering accurate and reliable information will allow clinicians to counsel patients based on scientific research to make education decisions rather than on fear of the unknown.” – by Alexandra Todak
Disclosure: Nezhat reports consultant/advisory roles with Karl Storz Endoscopy, Plasma Surgical and SurgiQuest. The researchers report no relevant financial disclosures.
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