Risk of morcellation of uterine leiomyosarcomas in laparoscopic supracervical hysterectomy and laparoscopic myomectomy, a retrospective trial including 4791 women.

STUDY

OBJECTIVE

To evaluate the incidence of uterine leiomyosarcomas (LMSs). To identify the risk of morcellating LMS in a gynecological department that offers laparoscopic supracervical hysterectomy (LSH) and laparoscopic myomectomy as primary surgical treatments.

DESIGN

A retrospective trial.

DESIGN CLASSIFICATION: Canadian Task Force Classification III.

SETTING

Norwegian university teaching hospital.

PATIENTS: Women diagnosed with uterine LMS and the total population of women who were referred for surgical treatment of uterine fibroids from January 1, 2000 to December 31, 2013.

INTERVENTIONS: Surgical treatment of fibroids, including LSH, abdominal supracervical hysterectomy, total laparoscopic hysterectomy, total abdominal hysterectomy, laparoscopic myomectomy, and hysteroscopic resection of fibroids.

MEASUREMENTS AND MAIN

RESULTS

A total of 4791 women were included in this trial; 1957 laparoscopic procedures were performed, and a morcellator was used in 1846 of the procedures. Twenty-six women were diagnosed with uterine LMS specimens after surgery. The mean ± SD age of women with LMS was 61.2 ± 12.3 years, and the mean ± SD of the tumor size at time of diagnosis was 90.9 ± 45.4 mm. Of these 26 women, 6 were diagnosed with uterine LMS by endometrial biopsy before surgical treatment, and 14 women were treated by open hysterectomy and bilateral salpingo-oophorectomy due to a clinical preoperative suspicion of a malignant condition. Consequently, 6 women with uterine LMS were treated according to the protocol for anticipated benign fibroids. Five of these women underwent laparotomy due to tumor size. LSH was performed in 1 woman, and a morcellator was used for tissue extraction. The incidence of uterine LMS in the population of women referred for anticipated benign fibroids was 0.0054 (1 in 183 women). The rate of unintended morcellation of a LMS at our department between January 1, 2000 and December 31, 2013 was 0.0002 (1 in 4791 women).

CONCLUSION

The incidence of uterine LMS was comparable with the incidence reported in the literature. The risk of unintended morcellation of uterine LMS after a preoperative selection of women with fibroids appears to be very low.