On Tuesday, July 22 a new study found that a surgical technique used in hysterectomies may help spread cancer. The technique, known as morcellation, is a minimally invasive surgery which involves cutting the uterus into smaller fragments for removal. According to the study, morcellation can disperse undetected cancer.
Performing a hysterectomy with morcellation involves surgeons using a power cutter to cut the uterine tissue into smaller pieces, which are then removed through small incisions in the abdomen with a tube or laparoscope. Researchers found that 27 out of every 10,000 women who had a hysterectomy using this technique had undetected uterine cancer at the time of the surgery. The odds were highest for those over the age of 65, researchers found.
“With this procedure, you are breaking up the uterus,” explained study researcher Dr. Jason Wright, chief of gynecologic oncology at the Columbia University College of Physicians and Surgeons in New York City. “You are essentially cutting through a cancer [if it is present] and that could theoretically spread the cancer to outside the uterus.”
In a conventional hysterectomy, the uterus is removed in one piece, which eliminates the risk of cutting through the cancer and potentially spreading it. In April, the U.S. Food and Drug Administration issued a safety alert regarding the use of morcellation because of the cancer risk. The FDA notes that there are other, safer alternatives to morcellation, and they are continuing to study the procedure.
The new study, published on July 22 in the Journal of the American Medical Association, involved evaluating insurance data from over 500 hospitals. Wright explains that the new study differs from previous studies, which focused on reports from single hospitals and estimated the risk at 9 to 100 of every 10,000 women who had the procedure.
According to the U.S. Centers for Disease Control and Prevention, approximately 500,000 hysterectomies are performed each year in the United States to treat afflictions such as uterine cancer and fibroids.
In the study, Wright found over 230,000 women who had minimally invasive hysterectomy between 2006 and 2012, and of those about 36,000 women underwent morcellation. Of the 36,000 women, 99 cases of uterine cancer were identified, which comes out to 27 women in every 10,000.
The study also found that a woman’s age has an affect on her likelihood to have underlying cancer. The older the woman, the more likely she was to have an undetected malignancy; while 6 women under the age of 40 had uterine cancer detected after morcellation, 24 women 65 years of age and older did, which is an 36 percent increase.
Dr. Michael Strongin, chief of gynecologic surgery at Lenox Hill Hospital in New York City, asserts that the study provides pertinent new information about the risks of morcellation as they relate to older women. “I think the important take-home is, the older the patient who is undergoing a procedure like power morcellation, the greater the potential for finding unsuspected malignancies,” said Strongin, who was not involved in the study. “Consequently, that should be a tremendous factor in physicians deciding whether it is appropriate to use that particular technique.”