Effects of morcellation on long-term outcomes in patients with uterine leiomyosarcoma

Sarcoma of the Uterus. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry No. 015/074, April 2021)

“…However, there was no difference in the rate of extra-abdominal recurrence. These data have been confirmed by further studies 9 , 117 , 118 , 119 , 120 but not by all 121 – 124 . In a large retrospective series of 843 occult endometrial carcinomas and 334 occult uterine sarcomas, the cancer-specific 5-year mortality after hysterectomy with morcellation was significantly higher compared to procedures without morcellation (hazard ratio [HR] 2.66; 95% CI 1.11 – 6.37) 111 .…”

“…Die extraabdominale Rezidivrate hingegen war nicht unterschiedlich. Diese Daten wurden durch weitere 9 , 117 , 118 , 119 , 120 , nicht jedoch alle Studien 121 , 122 , 123 , 124 bestätigt. In einer großen retrospektiven Serie mit 843 okkulten Endometriumkarzinomen und 334 okkulten uterinen Sarkomen war die krebsspezifische 5-Jahres-Mortalität nach Hysterektomie mit Morcellierung gegenüber ohne Morcellierung signifikant erhöht (Hazard Ratio [HR] 2,66; 95%-KI 1,11 – 6,37) 111 .…”

Prevalence of undiagnosed uterine leiomyosarcoma in women undergoing hysterectomy or myomectomy for benign indications

“…Morcellation of the uterus or leiomyomas during MIS is at the centre of a current scientific debate [27]. While some authors found an increased risk of intra-abdominal recurrence and lower overall survival when LMS were accidentally morcellated [28,29], other authors found contradictory results [30,31]. All these studies were retrospective referral or cancer centre studies with heterogeneous surgical approaches (vaginally, open surgery, laparoscopy or hysteroscopy), and most combined different types of morcellation (scalpel, power morcellation etc.).…”

Is Laparoscopic Power Morcellation of Fibroids a Cardinal Sin in 2017?

“…In cases where tissue retrieval is performed through morcellation, there is increasing concern that intra-abdominal dispersion of occult uterine malignancies may lead to peritoneal dissemination and worse outcomes [4]. Gynecologic laparoscopic power morcellation (LPM) has come under increased scrutiny over the last 2 years due to widespread attention to a known but rare complication, an unanticipated dissemination of malignancy, namely occult uterine leiomyosarcoma [5][6][7]. Three years ago, the Food and Drug Administration in the United States of America (FDA) issued the alert on power morcellation for uterine leiomyomas, addressing the risk of malignant cell spreading within the abdominal cavity (actual risk assessment from 1 in 360 to 1 in 7400 cases) [8].…”