Incidental power morcellation of malignancy: a retrospective cohort study.
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 293.5g whereas the median weight for the benign uteri was only 117.5g 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.
Atlantic Health System, Department of Obstetrics, Gynecology, and Women's Health, Morristown, NJ, United States.
Kerry
K
Graebe
Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami, FL, United States.
Arlene
A
Garcia-Soto
Atlantic Health System, Department of Obstetrics, Gynecology, and Women's Health, Morristown, NJ, United States.
Michael
M
Aziz
Atlantic Health System, Department of Obstetrics, Gynecology, and Women's Health, Morristown, NJ, United States.
Vanessa
V
Valarezo
Atlantic Health System, Division of Gynecologic Oncology, Carol G. Simon Cancer Center, Morristown, NJ, United States.
Paul B
PB
Heller
Atlantic Health System, Division of Gynecologic Oncology, Carol G. Simon Cancer Center, Morristown, NJ, United States.
Nana
N
Tchabo
Atlantic Health System, Division of Gynecologic Oncology, Carol G. Simon Cancer Center, Morristown, NJ, United States.
Daniel H
DH
Tobias
Atlantic Health System, Division of Pelvic Floor and Reconstructive Surgery, Morristown, NJ, United States.
Charbel
C
Salamon
Atlantic Health System, Department of Obstetrics, Gynecology, and Women's Health, Morristown, NJ, United States.
Joseph
J
Ramieri
Atlantic Health System, Department of Pathology, Morristown, NJ, United States.
Craig
C
Dise
Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami, FL, United States. Electronic address: bxs255@med.miami.edu.
Brian M
BM
Slomovitz
D015331:Cohort Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D007889:Leiomyoma / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies; D063186:Uterine Myomectomy / Q000379:methods; D014594:Uterine Neoplasms / Q000473:pathology* / Q000601:surgery
Malignancy; Minimally-invasive; Morcellation; Sarcoma