Laparoscopic Hysterectomy with Morcellation Shown to Have Fewer Overall Deaths, Surgical Complications and Increased Quality of Life for Women

A decision-tree analysis predicted fewer overall deaths, fewer surgical complications, and increased quality of life for women who underwent laparoscopic hysterectomy with morcellation compared with abdominal hysterectomy for presumed fibroid uterus, reported researchers.

But there were more deaths from leiomyosarcoma after laparoscopic hysterectomy, wrote Matthew Siedhoff, MD, an ob/gyn physician at the University of North Carolina School of Medicine in Chapel Hill, and colleagues, in the American Journal of Obstetrics and Gynecology.

Using morbidity and mortality data from 26 previous studies spanning several decades, researchers constructed a decision tree for a hypothetical cohort of 100,000 premenopausal women over a 5-year time period who had a hysterectomy for presumed uterine fibroids.

More Data to Better Inform Consent

The goal of the study was to provide physicians with better estimates of health outcomes when considering surgical approaches for uterine fibroids, authors said.

The study is consistent with previous research, Hal Lawrence, MD, of Georgetown University Hospital in Washington, D.C., and executive vice president and CEO of the American College of Obstetricians and Gynecologists, told MedPage Today in an email.

“Obstetrician-gynecologists understand that total abdominal hysterectomy has higher rates of morbidity and mortality than less-invasive alternatives, including those conducted with morcellation. Based on previous data, we continue to assert that vaginal hysterectomy offers patients fewer complications and better outcomes for patients, so is the preferred route of hysterectomy when possible,” he wrote.

“Of course, there is no one-size-fits-all solution for the treatment of fibroids. Not all women are indicated for vaginal hysterectomy, so it is essential that laparoscopic hysterectomy with morcellation and total abdominal hysterectomy continue to be available as treatment options,” Lawrence added.

True informed consent is key, Diana Bitner, MD, an obstetrician/gynecologist and director of Women’s Health Network at Spectrum Health in Grand Rapids, Mich., told MedPage Today in an email.

“I agree with the findings and think women deserve informed consent that, while cancer being spread is a risk of morcellation, most women do not have cancer to be spread and … so many other risks [are reduced] with laparoscopic surgery,” she said.

Warnings Over the Years

The findings add to the debate about the use of morcellation to remove uterine leiomyomas, which has embroiled the ob/gyn community for the last year and a half.

In April 2014, the FDA discouraged the use of power morcellators with hysterectomy because the devices posed “a risk of spreading unsuspected cancerous tissue, notably uterine sarcomas.”

A review published in the Journal of the American Medical Association in July 2014 quantified the risk. Looking at more than 200,000 cases, researchers found that one of every 368 women who underwent treatment with a power morcellator had unsuspected uterine cancer identified during or after the procedure.

In December 2013, the Society of Gynecologic Oncology (SGO) published a position statement advising physicians and patients to have a thorough discussion of the risks and benefits of undergoing morcellation. The SGO added that the procedure is “generally contraindicated in the presence of documented or highly suspected malignancy and may be inadvisable in premalignant conditions or risk-reducing surgery.”

Meanwhile, editors of the The Lancet took a harder line in a February 2014 editorial. “New techniques and devices should be proven safe before widespread acceptance, rather than being widely used until proven hazardous,” they wrote.

Study authors noted limitations due to lack of data. “The model assumed that the behavior of a morcellated leiomyosarcoma would mimic that of a spontaneous disease spread. A better understanding of the impact of leiomyosarcoma morcellation could alter the conclusions of our model, either positively or negatively,” they wrote.

Additional limitations included the unrandomized nature of the analysis and scarce data on the impact of complications on quality-adjusted life years, they said.

Read the full story Fibroid Morcellation Gets Boost From New Study

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