Incidence of Occult Uterine Malignancy Following Vaginal Hysterectomy With Morcellation

Megan Wasson, Paul Magtibay, Paul Magtibay, Javier Magrina

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Study Objective: To determine the incidence and impact of occult uterine malignancy following vaginal hysterectomy and uncontained morcellation. Design: An Institutional Review Board-approved retrospective cohort study (Canadian Task Force classification II-2). Setting: Three academic medical centers. Patients: All women who underwent vaginal hysterectomy between January 1, 2008, and August 31, 2015, at 3 institutions were considered for inclusion in the study. Interventions: Total vaginal hysterectomy with and without morcellation. Measurements and Main Results: A total of 2296 women underwent total vaginal hysterectomy without (n = 1685) or with (n = 611) vaginal morcellation performed via cold-knife wedge resection. All patients requiring morcellation had benign indications for hysterectomy. The incidence of occult uterine malignancy among hysterectomies requiring vaginal morcellation was 0.82% (n = 5) and included stage IA, grade I endometrial adenocarcinoma (n = 3; 0.49%) and low grade stromal sarcoma (n = 2; 0.33%). Demographic data for those with occult malignancy included mean age 48.8 years, mean body mass index 32.36 kg/m2, and median parity 2. Indication for hysterectomy was abnormal uterine bleeding for the 5 patients who underwent morcellation and were found to have a malignancy. Final pathology revealed a mean uterine weight of 231.60 g. All patients have remained disease-free, and no deaths have occurred. Mean disease-free survival was 48.33 months (range, 33-67 months) for the patients with endometrial adenocarcinoma and 42.0 months (range, 19-65 months) for the patients with stromal sarcoma for the 5 patients who underwent vaginal hysterectomy with morcellation. Conclusion: Among patients undergoing vaginal hysterectomy with morcellation, the incidence of occult uterine carcinoma is 0.82%. Uncontained vaginal morcellation when used concomitantly with vaginal hysterectomy does not appear to negatively impact patient prognosis or outcomes.

Original languageEnglish (US)
JournalJournal of Minimally Invasive Gynecology
DOIs
StateAccepted/In press - Nov 29 2016

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Vaginal Hysterectomy
Incidence
Neoplasms
Hysterectomy
Sarcoma
Adenocarcinoma
Morcellation
Uterine Hemorrhage
Research Ethics Committees
Advisory Committees
Parity
Disease-Free Survival
Body Mass Index
Cohort Studies
Retrospective Studies
Demography
Pathology
Carcinoma
Weights and Measures

Keywords

  • Cancer
  • Morcellate
  • Uterus

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Incidence of Occult Uterine Malignancy Following Vaginal Hysterectomy With Morcellation. / Wasson, Megan; Magtibay, Paul; Magtibay, Paul; Magrina, Javier.

In: Journal of Minimally Invasive Gynecology, 29.11.2016.

Research output: Contribution to journalArticle

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title = "Incidence of Occult Uterine Malignancy Following Vaginal Hysterectomy With Morcellation",
abstract = "Study Objective: To determine the incidence and impact of occult uterine malignancy following vaginal hysterectomy and uncontained morcellation. Design: An Institutional Review Board-approved retrospective cohort study (Canadian Task Force classification II-2). Setting: Three academic medical centers. Patients: All women who underwent vaginal hysterectomy between January 1, 2008, and August 31, 2015, at 3 institutions were considered for inclusion in the study. Interventions: Total vaginal hysterectomy with and without morcellation. Measurements and Main Results: A total of 2296 women underwent total vaginal hysterectomy without (n = 1685) or with (n = 611) vaginal morcellation performed via cold-knife wedge resection. All patients requiring morcellation had benign indications for hysterectomy. The incidence of occult uterine malignancy among hysterectomies requiring vaginal morcellation was 0.82{\%} (n = 5) and included stage IA, grade I endometrial adenocarcinoma (n = 3; 0.49{\%}) and low grade stromal sarcoma (n = 2; 0.33{\%}). Demographic data for those with occult malignancy included mean age 48.8 years, mean body mass index 32.36 kg/m2, and median parity 2. Indication for hysterectomy was abnormal uterine bleeding for the 5 patients who underwent morcellation and were found to have a malignancy. Final pathology revealed a mean uterine weight of 231.60 g. All patients have remained disease-free, and no deaths have occurred. Mean disease-free survival was 48.33 months (range, 33-67 months) for the patients with endometrial adenocarcinoma and 42.0 months (range, 19-65 months) for the patients with stromal sarcoma for the 5 patients who underwent vaginal hysterectomy with morcellation. Conclusion: Among patients undergoing vaginal hysterectomy with morcellation, the incidence of occult uterine carcinoma is 0.82{\%}. Uncontained vaginal morcellation when used concomitantly with vaginal hysterectomy does not appear to negatively impact patient prognosis or outcomes.",
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