Hysterectomy Technique Tied to Poorer Uterine Cancer Outcomes
Uncontained uterine power morcellation tied to higher mortality in women with undetected uterine cancer
MONDAY, Oct. 7, 2019 (HealthDay News) -- Uncontained power morcellation is associated with a higher mortality risk in women with occult uterine sarcoma, especially in those with occult leiomyosarcoma, according to a study published online Sept. 16 in the Journal of Clinical Oncology.
Xiao Xu, Ph.D., from Yale University in New Haven, Connecticut, and colleagues linked statewide hospital discharge records to cancer registry data in New York to identify 843 women with occult endometrial carcinoma and 334 women with occult uterine sarcoma who underwent a hysterectomy or myomectomy (from Oct. 1, 2003, through Dec. 31, 2013). Comparisons were made between women undergoing laparoscopic supracervical hysterectomy/laparoscopic myomectomy (LSH/LM), a surrogate indicator for uncontained power morcellation, versus women who underwent supracervical abdominal hysterectomy and total abdominal hysterectomy (TAH), which did not involve power morcellation.
The researchers found that among women with occult uterine sarcoma, LSH/LM was associated with a higher risk for disease-specific mortality than TAH (adjusted hazard ratio [aHR], 2.66; adjusted difference in five-year disease-specific survival, −19.4 percent). Among women with leiomyosarcoma, LSH/LM was associated with an increased risk for disease-specific mortality versus supracervical abdominal hysterectomy (aHR, 3.64; adjusted difference in five-year disease-specific survival, −31.2 percent) and TAH (aHR, 4.66; adjusted difference in five-year disease-specific survival, −37.3 percent). No significant association was noted between the surgical approach and disease-specific mortality among women with occult endometrial carcinoma.
"For patients at higher risk for uterine cancer, such as postmenopausal women, it may be helpful to avoid uncontained power morcellation if possible," Xu said in a statement.