title: Laparoscopic hysterectomy with morcellation vs abdominal hysterectomy for presumed fibroids: an updated decision analysis following the 2014 Food and Drug Administration safety communications.
abstract: Previous decision analyses demonstrate the safety of minimally invasive hysterectomy for presumed benign fibroids, accounting for the risk of occult leiomyosarcoma and the differential mortality risk associated with laparotomy. Studies published since the 2014 Food and Drug Administration safety communications offer updated leiomyosarcoma incidence estimates. Incorporating these studies suggests that mortality rates are low following hysterectomy for presumed benign fibroids overall, and a minimally invasive approach remains a safe option. Risk associated with morcellation, however, increases in women age >50 years due to increased leiomyosarcoma rates, an important finding for patient-centered discussions of treatment options for fibroids.
authors.affiliation: Center for Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: Matthew.Siedhoff@cshs.org.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Siedhoff
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle, WA.
authors.forename: Kemi M
authors.initials: KM
authors.lastname: Doll
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Clarke-Pearson
authors.affiliation: Department of Health Policy and Management, School of Medicine, University of North Carolina, Chapel Hill, NC.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Rutstein
mesh_terms: D003661:Decision Support Techniques; D003663:Decision Trees; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy; D007889:Leiomyoma / Q000175:diagnosis / Q000601:surgery*; D007890:Leiomyosarcoma / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D008875:Middle Aged; D000069577:Morcellation; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D014481:United States; D014486:United States Food and Drug Administration; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000601:surgery*
keywords: decision-analysis; fibroid; hysterectomy; laparoscopy; leiomyoma; leiomyosarcoma; morcellation; mortality; myoma