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WASHINGTON – There were no cases of unexpected leiomyosarcomas in a retrospective chart study of about 1,600 cases of vaginal or laparoscopic-assisted vaginal hysterectomies performed over a 7-year period.
In the study, the rate of endometrial adenocarcinomas was about 1 in 200, and while the overall manual vaginal morcellation rate was 19%, no uterine malignancies were morcellated, said Dr. Pedro Maldonado of the division of female pelvic medicine and reconstructive surgery at the University of Texas Southwestern Medical Center, Dallas.
The review looked at all total vaginal hysterectomy (TVH) and laparoscopic-assisted vaginal hysterectomy (LAVH) cases performed at the three main teaching hospitals of the university from July 2006 through March 2013. Malignancies known before surgery were excluded.
There were a total of 1,608 cases: 1,091 TVH and 517 LAVH procedures. The overall morcellation rate was 19%: 32% in the TVH group and 13% in the LAVH group, Dr. Maldonado reported at the scientific meetings of the American Urogynecologic Society and the International Urogynecological Association.
Among the 1,608 cases, there were no cases of leiomyosarcoma (LMS) diagnosed on pathology. There was one case of an endometrial adenosarcoma (0.06%) in a 37-year-old patient with a preoperative diagnosis of menorrhagia and fibroids, and one case of a low-grade endometrial stromal tumor (0.06%) in a 39-year-old patient also diagnosed with menorrhagia and fibroids preoperatively. Neither of these patients underwent morcellation.
Three patients (0.19%) – aged 32, 38, and 47 years – who had preoperative diagnoses of menorrhagia, fibroids, and/or anemia had a pathologic diagnosis of smooth muscle tumor of uncertain malignant potential. One of these three patients underwent morcellation.
Another 8 (0.50%) of the patients with a preoperative diagnosis of endometrial hyperplasia were diagnosed with endometrial adenocarcinoma on pathology; none of them underwent morcellation, Dr. Maldonado said.
The risk of intraperitoneal dissemination of an unexpected LMS during endoscopic power morcellation has become a major issue since the Food and Drug Administration recommended in April 2014 that the use of power morcellation during a hysterectomy or myomectomy for uterine fibroids be discouraged because of the risk of disseminating cancerous tissue and upstaging disease. The FDA estimates that about 1 in 350 women undergoing hysterectomy or myomectomy for presumed fibroids have an unsuspected uterine sarcoma and that the risk of an unsuspected LMS is about 1 in 500.
Dr. Maldonado said he had no relevant financial disclosures.
