Uterine Malignancy Rare Among Myomectomy Patients

Uterine cancer and premalignant lesions are rare among women undergoing myomectomy

medwireNews: Uterine cancer and precancerous lesions are rare among women undergoing myomectomy and there is no significant correlation between uterine cancer and use of electric power morcellation during the procedure, study findings suggest.

The analysis included 41,777 US women who underwent uterine leiomyoma excision between 2006 and 2012, 7.7% of whose procedure included electric power morcellation, report Jason Wright, from Columbia University in New York, and co-workers.

Uterine cancer was present in 0.19% of patients who underwent myomectomy without morcellation, equalling one case per 528 women, versus 0.09% and one case per 1073 women for those who underwent power morcellation.

The rates for uterine tumours of uncertain malignant potentiation were 0.08% and 0.06%, respectively, with corresponding rates for any pathological outcome of 0.67% and 0.43%.

In multivariate analysis, the prevalence of uterine cancer was not significantly associated with electric power morcellation, the team reports in JAMA Oncology.

Indeed, advanced age was the strongest risk factor for pathological findings in women who underwent uterine leiomyoma excision, regardless of technique.

Among patients who underwent myomectomy without power morcellation, pathological abnormalities affected just 0.28% of patients aged less than 40 years versus 6.91% of women aged 60 years or older. The corresponding values for patients who underwent myomectomy with power morcellation were 0.15% and 4.08%.

But the researchers observe that the risk of malignant neoplasms associated with power morcellation during myomectomy is lower than previously reported for hysterectomy with power morcellation.

Noting that hysterectomy is the “surgical treatment of choice” for women who have completed childbearing, while myomectomy is preferred for younger patients, they say: “These data have important implications for older women considering myomectomy and suggest that electric power morcellation should be approached with caution in older women.”

Ceana Nezhat, from the Atlanta Center for Minimally Invasive Surgery and Reproductive Medicine in Georgia, USA, writes in an invited commentary that the lack of data on the risk of tumour dissemination during myomectomy, regardless of morcellation, means the “magnitude of harm is unknown.”

“Consequently, not only morcellation, but the prevalence of malignant and premalignant uterine lesions in younger patients, calls for investigation”, he adds.

References

Wright JD, Tergas AI, Cui R, et al. Use of electric power morcellation and prevalence of underlying cancer in women who undergo myomectomy. JAMA Oncol 2015; Advance online publication 19 February. doi:10.1001/jamaoncol.2014.206

Nezhat C. The dilemma of myomectomy, morcellation and the demand for reliable metrics on surgical quality. JAMA Oncol 2015; Advance online publication 19 February. doi:10.1001/jamaoncol.2014.184

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