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Stereotactic Radiosurgery for Gynecologic Cancer
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Morcellation in gynecologic oncology.

Eva Chalas1

  • 1Department of Obstetrics and Gynecology, Center for Cancer Care, NYU Winthrop Hospital, Mineola, New York, USA.

Current Opinion in Obstetrics & Gynecology
|December 19, 2017
PubMed
Summary

Morcellation of uteri with unsuspected malignancies is a concern. Current guidelines advise against morcellation if malignancy is suspected, emphasizing clinical judgment and patient awareness of diagnostic limitations for occult leiomyosarcoma.

Area of Science:

  • Gynecologic oncology
  • Surgical safety
  • Medical device regulation

Background:

  • Morcellation of uteri with unsuspected malignancies has been a long-standing concern.
  • Recent FDA statements have prompted more intensive evaluation of clinical outcomes and practice changes regarding power morcellators.
  • This review synthesizes key publications on the topic.

Purpose of the Study:

  • To summarize relevant publications on the clinical outcomes and practice impacts related to uterine morcellation, particularly concerning unsuspected malignancies.
  • To review the current recommendations and evidence regarding the use of power morcellators in gynecologic surgery.

Main Methods:

  • Literature review of relevant publications.
  • Synthesis of findings from professional society guidelines (Society of Gynecologic Oncology, American College of Obstetricians and Gynecologists).

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  • Analysis of reported clinical outcomes, complication rates, and societal costs associated with uterine morcellation.

    • Main Results:

    • Professional societies recommend against morcellation when malignancy is suspected or diagnosed, acknowledging limitations in detecting occult leiomyosarcoma.
    • Accurate incidence of occult leiomyosarcoma remains unknown due to poor data quality.
    • FDA safety communications have led to decreased laparoscopic hysterectomy rates, with reported increases in complication rates and societal costs for abdominal procedures.

    Conclusions:

    • Clinical judgment and adherence to guidelines based on scientific evidence are recommended.
    • Patients must be informed about the limitations of current data regarding occult malignancies and diagnostic testing.
    • Minimally invasive surgery, avoiding morcellation when malignancy is suspected, is associated with better outcomes and quality of life; research should focus on improving diagnostic accuracy and therapeutic efficacy.