Incidence of Occult Uterine Malignancy Following Vaginal Hysterectomy With Morcellation

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.