Incidence of Uterine Leiomyosarcomas After Laparoscopic Power Morcellation in a Community Setting [331]

摘要

INTRODUCTION: The recent discussion around power morcellation in gynecologic surgeries resulted in a U.S. Food and Drug Administration (FDA) filing in December 2013 bringing attention to the occurrence of unsuspected uterine leiomyosarcoma during routine hysterectomy or myomectomy. In this FDA filing, the incidence of unsuspected cancer was estimated to be one in every 350 cases. It has been difficult to asses the actual incidence of uterine leiomyosarcoma given their rarity and the inability to capture this diagnosis through International Classification of Diseases, 9th Revision searches. METHODS: We reviewed all benign robotic-assisted hysterectomies or robotic-assisted myomectomies from 2006 to 2014. Data were collected by performing a search of all gynecologic pathology reports using variations of “morcellation” at The Valley Hospital in Ridgewood, New Jersey, and identifying pathology. RESULTS: During this 8-year time period, 763 morcellations of uteri or leiomyomas were performed by surgeons at The Valley Hospital. There was one case of morcellated uterine leiomyosarcoma producing a rate of one in 763 or an incidence of 0.13%. CONCLUSION AND IMPLICATION: Our data report a low incidence of unsuspected uterine leiomyosarcoma during laparoscopic power morcellation. This incidence compares similarly to other reports specific to leiomyosarcoma. With careful patient selection and informed consent, power morcellation should remain a safe and important tool in the gynecologist's armamentarium.