title: Malignancy rate of 10,731 uteri morcellated during laparoscopic supracervical hysterectomy (LASH).
abstract: OBJECTIVE
  This study aims to evaluate the number of cases of occult uterine malignancies in all LASH surgeries at the MIC clinic (Berlin) and to verify how the operative technique affects the prognosis of the disease.
  
  
  METHODS
  Data of 10,731 patients who underwent a standardized LASH surgery with electric power morcellation between 1998 and April 30, 2014 were retrospectively analyzed. Main indication for LASH was symptomatic uterine myomas (81.3 %).
  
  
  RESULTS
  No intra-operative complication was caused by use of a morcellator. In total, six sarcomas (0.06 %), including four endometrial stromal sarcomas (0.04 %) two leiomyosarcomas (0.02 %), and eight endometrial cancers (0.07 %) were documented. This amounts to a very low uterine malignancy rate of 0.13 %. Median follow-up period for all six patients with sarcoma and seven patients with endometrial cancer was 65.58 months (13-169). No recurrence was reported for the patients with endometrial cancer and five sarcoma patients in the comprehensible follow-up period. One patient died 13 months after LASH surgery due to the diagnosed leiomyosarcoma with peritoneal carcinomatosis and bone metastases.
  
  
  CONCLUSIONS
  In 10,731 morcellated uteri during LASH only 0.06 % sarcoma and 0.07 % endometrial carcinoma were detected. All patients should be informed about the rare possibility of a malignant disease during pre-operative counseling. With a timely follow-up surgery according to the oncologic guidelines, our data suggest a very good prognosis in terms of survival after LASH with morcellation of malignant tumors in the uterus.
authors.affiliation: Klinik für Minimal Invasive Chirurgie, Kurstraße 11, 14129, Berlin-Zehlendorf, Germany, b.bojahr@mic-berlin.de.
authors.forename: Bernd
authors.initials: B
authors.lastname: Bojahr
authors.forename: Rudy Leon
authors.initials: RL
authors.lastname: De Wilde
authors.forename: Garri
authors.initials: G
authors.lastname: Tchartchian
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000601:surgery; D016889:Endometrial Neoplasms / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007044:Hysterectomy; D007431:Intraoperative Complications / Q000601:surgery; D010535:Laparoscopy; D007889:Leiomyoma / Q000601:surgery*; D007890:Leiomyosarcoma / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D012189:Retrospective Studies; D012509:Sarcoma / Q000601:surgery; D018203:Sarcoma, Endometrial Stromal; D016896:Treatment Outcome; D063186:Uterine Myomectomy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D014594:Uterine Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*
references.citation: CA Cancer J Clin. 2001 Jan-Feb;51(1):15-36
references.pmid: 11577478
references.citation: Gynecol Oncol. 2011 Aug;122(2):255-9
references.pmid: 21565389
references.citation: Arch Gynecol Obstet. 2013 Mar;287(3):455-62
references.pmid: 23053310
references.citation: BJOG. 2009 Mar;116(4):492-500
references.pmid: 19016683
references.citation: Am J Obstet Gynecol. 1990 Apr;162(4):968-74; discussion 974-6
references.pmid: 2327466
references.citation: Obstet Gynecol. 2003 Sep;102(3):453-62
references.pmid: 12962924
references.citation: J Minim Invasive Gynecol. 2011 Jan-Feb;18(1):1-3
references.pmid: 21059487
references.citation: J Minim Invasive Gynecol. 2005 Mar-Apr;12(2):121-4
references.pmid: 15904614
references.citation: Obstet Gynecol. 1994 Jun;83(6):1015-20
references.pmid: 8190416
references.citation: Gynecol Oncol. 2009 Jun;113(3):324-6
references.pmid: 19342083
references.citation: JSLS. 2013 Jan-Mar;17(1):107-10
references.pmid: 23743380
references.citation: Gynecol Obstet Invest. 1994;38(4):272-5
references.pmid: 7851814
references.citation: J Minim Invasive Gynecol. 2006 May-Jun;13(3):183-9
references.pmid: 16698522
references.citation: Baillieres Clin Obstet Gynaecol. 1989 Sep;3(3):655-81
references.pmid: 2533017
references.citation: J Clin Oncol. 2009 Apr 20;27(12):2066-72
references.pmid: 19255317
references.citation: J Reprod Med. 1993 Oct;38(10):763-7
references.pmid: 8263863
references.citation: Gynecol Oncol. 2004 Sep;94(3):818-20
references.pmid: 15350379
references.citation: Eur J Cancer. 1991;27(9):1095-9
references.pmid: 1835616
references.citation: Int J Radiat Oncol Biol Phys. 1980 Jul;6(7):899-902
references.pmid: 7204130
references.citation: Acta Obstet Gynecol Scand. 2007;86(2):133-44
references.pmid: 17364274
references.citation: J Natl Cancer Inst. 1984 Sep;73(3):667-71
references.pmid: 6590913
references.citation: Obstet Gynecol. 1991 Jun;77(6):954-6
references.pmid: 2030877
references.citation: Gynecol Oncol. 2008 Jul;110(1):43-8
references.pmid: 18445505
references.citation: JSLS. 2009 Apr-Jun;13(2):129-34
references.pmid: 19660203