Research by Dana-Farber Cancer Institute scientists supports the U.S. Food and Drug Administration’s recent warning about laparoscopic power morcellation, a procedure sometimes used to remove the uterus and uterine fibroids, noncancerous growths that often appear during childbearing years. The FDA based its warning on data suggesting that the procedure may spread unsuspected cancerous tissue beyond the uterus.
The procedure involves an electrical device, a morcellator, that slices uterine tissue into pieces that are removed through small incisions in the abdomen. Such “minimally invasive” surgery is often preferred to traditional, open-abdominal surgery because it can lower the risk of infection and other complications. It’s estimated that about 50,000 women a year in the United States undergo hysterectomies with laparoscopic power morcellation.
The procedure has received increased scrutiny in recent years because of concerns that some patients may have undetected uterine cancers known as sarcomas, and that morcellation may inadvertently scatter cancer cells through the abdomen. There currently is no reliable method of identifying sarcomas in the uterus before surgery. Earlier this week, Johnson & Johnson, the largest manufacturer of morcellators, announced it was withdrawing the tool from the market.
Recently, Dana-Farber’s Suzanne George, MD, and her colleagues published a study in the journal Cancer that tracked uterine sarcomas in women who had undergone hysterectomies, either by power morcellation or traditional abdominal surgery. Here, she discusses her research.
Q: What did your most recent study find?
A: We examined the medical records of hundreds of women with a diagnosis of uterine leiomyosarcoma who were seen at Dana-Farber, Brigham and Women’s Hospital and Massachusetts General Hospital from 2007 to 2012, and we compared the outcomes of patients who underwent total abdominal hysterectomies (TAHs) with those of patients who received laparoscopic intraperitoneal power morcellation hysterectomies because they were thought to have fibroids prior to surgery. We found that the risk of recurrence of sarcoma was four times higher in the morcellation group than in the TAH group. We also found that the sarcomas generally recurred more quickly in the morcellation group – an average of 11 months, compared to more than three years in the TAH group, and that the recurrences following morcellation were more likely to be in the abdomen or pelvis.
Q: What led you to undertake this research?
A: I specialize in sarcomas, cancers of the connective tissue. A significant proportion of my practice is caring for women with uterine leiomyosarcoma, which, although uncommon, is the most common sarcoma of the uterus. Some of my patients have had hysterectomies involving morcellation because, before surgery, the growth in the uterus was thought to be a benign fibroid, which is very common. Unfortunately, the final pathology exams of the removed tissue found the presence of sarcoma cells. I was concerned that intraperitoneal morcellation of a uterine sarcoma might lead to worse outcomes than traditional abdominal hysterectomies because the tumor is cut up within the abdominal cavity as part of the removal process.
Q: What message should women take from your study?
A: Women who are having a hysterectomy that involves the removal of uterine fibroids should be aware that intraperitoneal power morcellation can worsen the course of uterine sarcomas if such sarcomas are present before surgery. Because there is no way, prior to surgery, to distinguish benign fibroid tissue from uterine sarcoma tissue, all efforts to minimize intraperitoneal uterine morcellation should be considered.