Incidence of unexpected uterus malignomas after power morcellation and survival outcome's analysis. A retrospective multicenter study in Germany

Introduction:

Despite the important advantages of morcellation, it may be associated with dissemination of uterine tissue throughout the peritoneal cavity and spread of an occult malignoma, which can result in cancer upstaging. The aim of this study is to estimate the frequency of unexpected malignoma's appearance in morcellation and its clinical impacts.

Materials and methods:

This retrospective study included patients traced from 2008 – 2017. The authors identified women who underwent laparoscopically or robotically myomectomy or hysterectomy and the use of EMM.

Results:

The authors analysed 1226 patients who have had LASH (44%), TLH (6.8%) or myomectomy (49.2%). Unexpected malignancy after EMM was detected in 3 of 1226 patients, which represents the 0.24%. In all three cases the malignancy was proved to be a sarcoma (2xLS, 1xESS). The patients were treated with a re-operation for completion of staging. Only one of the three patients (case I) showed intraabdominal recurrence after 63 months which could be treated with a third operation, where complete resection could be achieved. The other two cases had a follow up of 42 (case II) and 31 (case III) months after the operation without evidence for intraabdominal recurrence. One of them (case II) exhibited sternal metastasis after 36 months. One case of vaginal manual morcellation of LS after TLH was detected.

Conclusion:

There is a small risk of occult malignoma in EMM to spread out. In high-risk patients, EMM should be avoided. The various methods' development of tissue extraction could minimise any dissemination risks.