title: Incidence of Occult Uterine Malignancy Following Vaginal Hysterectomy With Morcellation.
abstract: To determine the incidence and impact of occult uterine malignancy following vaginal hysterectomy and uncontained morcellation.
  
  
  
  An Institutional Review Board-approved retrospective cohort study (Canadian Task Force classification II-2).
  
  
  
  Three academic medical centers.
  
  
  
  All women who underwent vaginal hysterectomy between January 1, 2008, and August 31, 2015, at 3 institutions were considered for inclusion in the study.
  
  
  
  Total vaginal hysterectomy with and without morcellation.
  
  
  
  A total of 2296 women underwent total vaginal hysterectomy without (n = 1685) or with (n = 611) vaginal morcellation performed via cold-knife wedge resection. All patients requiring morcellation had benign indications for hysterectomy. The incidence of occult uterine malignancy among hysterectomies requiring vaginal morcellation was 0.82% (n = 5) and included stage IA, grade I endometrial adenocarcinoma (n = 3; 0.49%) and low grade stromal sarcoma (n = 2; 0.33%). Demographic data for those with occult malignancy included mean age 48.8 years, mean body mass index 32.36 kg/m2, and median parity 2. Indication for hysterectomy was abnormal uterine bleeding for the 5 patients who underwent morcellation and were found to have a malignancy. Final pathology revealed a mean uterine weight of 231.60 g. All patients have remained disease-free, and no deaths have occurred. Mean disease-free survival was 48.33 months (range, 33-67 months) for the patients with endometrial adenocarcinoma and 42.0 months (range, 19-65 months) for the patients with stromal sarcoma for the 5 patients who underwent vaginal hysterectomy with morcellation.
  
  
  
  Among patients undergoing vaginal hysterectomy with morcellation, the incidence of occult uterine carcinoma is 0.82%. Uncontained vaginal morcellation when used concomitantly with vaginal hysterectomy does not appear to negatively impact patient prognosis or outcomes.
authors.affiliation: Department of Gynecologic Surgery, Mayo Clinic Arizona, Phoenix, Arizona. Electronic address: wasson.megan@mayo.edu.
authors.forename: Megan
authors.initials: M
authors.lastname: Wasson
authors.affiliation: Department of Gynecologic Surgery, Mayo Clinic Arizona, Phoenix, Arizona.
authors.forename: Paul
authors.initials: P
authors.lastname: Magtibay
authors.affiliation: Department of Gynecologic Surgery, Mayo Clinic Arizona, Phoenix, Arizona.
authors.forename: Paul
authors.initials: P
authors.lastname: Magtibay
authors.affiliation: Department of Gynecologic Surgery, Mayo Clinic Arizona, Phoenix, Arizona.
authors.forename: Javier
authors.initials: J
authors.lastname: Magrina
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology; D000328:Adult; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000473:pathology; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects / Q000379:methods*; D015994:Incidence; D007889:Leiomyoma / Q000601:surgery; D008875:Middle Aged; D000069577:Morcellation / Q000009:adverse effects*; D011379:Prognosis; D012189:Retrospective Studies; D012509:Sarcoma / Q000601:surgery; D018203:Sarcoma, Endometrial Stromal / Q000473:pathology; D014594:Uterine Neoplasms / Q000473:pathology* / Q000601:surgery
keywords: Uterus; cancer; morcellate