title: Use of Electric Power Morcellation and Prevalence of Underlying Cancer in Women Who Undergo Myomectomy.
abstract: OBJECTIVE
  Myomectomy, the excision of uterine leiomyoma, is now commonly performed via minimally invasive surgery. Electric power morcellation, or fragmentation of the leiomyoma with a mechanical device, may be used to facilitate extraction of the leiomyoma.
  
  
  OBJECTIVE
  To analyze the prevalence of underlying cancer and precancerous changes in women who underwent myomectomy with and without electric power uterine morcellation.
  
  
  METHODS
  We used a US nationwide database to retrospectively analyze women who underwent myomectomy at 496 hospitals from January 2006 to December 2012. Use of electric power morcellation at the time of myomectomy was investigated. The prevalence of uterine cancer, uterine neoplasms of uncertain malignant potential, and endometrial hyperplasia were estimated. Multivariable mixed-effects regression models were developed to examine predictors of use of electric power morcellation and factors associated with adverse pathologic outcomes.
  
  
  METHODS
  Use of electric power morcellation at the time of myomectomy was examined. The occurrence of uterine cancer and precancerous uterine lesions was determined.
  
  
  RESULTS
  The cohort consisted of 41 777 women who underwent myomectomy at 496 hospitals and included 3220 (7.7%) who had electric power morcellation. Uterine cancer was identified in 73 (1 in 528) women who underwent myomectomy without electric power morcellation (0.19%; 95% CI, 0.15%-0.23%) and in 3 (1 in 1073) women who underwent electric power morcellation (0.09%; 95% CI, 0.02%-0.27%). The corresponding rates of any pathologic finding (cancer, tumors of uncertain malignant potential, or endometrial hyperplasia) were 0.67% (n = 257) (95% CI, 0.59%-0.75%) (1 in 150) and 0.43% (n = 14) (95% CI, 0.21%-0.66%) (1 in 230), respectively. Advanced age was the strongest risk factor for uterine cancer.
  
  
  CONCLUSIONS
  The prevalence of cancers and precancerous abnormalities of the uterus in women who undergo myomectomy with or without electric power morcellation is low overall, but risk increases with age. Electric power morcellation should be used with caution in older women undergoing myomectomy.
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York2Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York3New York Presbyteria.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York2Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York3New York Presbyteria.
authors.forename: Ana I
authors.initials: AI
authors.lastname: Tergas
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Rosa
authors.initials: R
authors.lastname: Cui
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York2Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York5Department of Medici.
authors.forename: William M
authors.initials: WM
authors.lastname: Burke
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York2Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York5Department of Medici.
authors.forename: June Y
authors.initials: JY
authors.lastname: Hou
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York4Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Cande V
authors.initials: CV
authors.lastname: Ananth
authors.affiliation: Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Ling
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Catherine
authors.initials: C
authors.lastname: Richards
authors.affiliation: Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York3New York Presbyterian Hospital, New York, New York4Department of Epidemiology, Mailman School of Public Health, Columbia University, New.
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.affiliation: Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York3New York Presbyterian Hospital, New York, New York4Department of Epidemiology, Mailman School of Public Health, Columbia University, New.
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
mesh_terms: D000328:Adult; D000367:Age Factors; D016009:Chi-Square Distribution; D016208:Databases, Factual; D011211:Electric Power Supplies; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D016014:Linear Models; D008875:Middle Aged; D000069577:Morcellation / Q000009:adverse effects / Q000295:instrumentation*; D015999:Multivariate Analysis; D018579:Patient Selection; D011230:Precancerous Conditions / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D063186:Uterine Myomectomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D014594:Uterine Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*