Morcellation risk and age
A look at the risk-benefit equation of power morcellation and age. Plus: Does exercise prior to pregnancy reduce pelvic pain in pregnancy? And, are hospitals doing enough to promote breastfeeding in new mothers?
Use of power morcellation for hysterectomy is controversial because of the potential for spread of undetected uterine cancer. The risk:benefit equation for the procedure may tilt based on age, according to results of a new study published in
Authored by scientists from Columbia University, the report is based on outcomes with a state transition Markov cohort simulation model of the risk and benefits of hysterectomy in women presumed to have benign gynecologic disease. The model took into consideration perioperative morbidity, mortality, risk of cancer and dissemination, and outcomes in women with an underlying malignancy. The data used came from the Surveillance, Epidemiology, and End Results (SEER) database and from the literature.
The researchers compared the risks and benefits of abdominal, laparoscopic, and laparoscopic hysterectomy with electric power morcellation. They found that in all scenarios modeled, laparoscopic hysterectomy without morcellation was the most beneficial strategy. Laparoscopic procedures with morcellation were associated with 80.83 more intraoperative complications, 199.64 fewer perioperative complications, and 241.80 fewer readmissions than abdominal hysterectomy per 10,000 women.
Excess cases of disseminated cancer per 10,000 women with morcellation compared with abdominal hysterectomy increased with age to 47.54 per 10,000 in women age 60 years and older. Compared with abdominal hysterectomy, this resulted in 0.30 (age 40–49 years), 5.07 (age 50–59 years), and 18.14 (age 60 years and older) excess deaths per 10 000 women in the respective age groups. Per 10,000 women younger than age 40, laparoscopic hysterectomy with morcellation was associated with 1.57 more cases of disseminated cancer and 0.97 fewer deaths than abdominal hysterectomy.
In women less than 50 years old, laparoscopic hysterectomy with morcellation was associated with fewer deaths than abdominal hysterectomy. The authors concluded that in older women, however, the risks of electric power morcellation may outweigh the benefits of minimally invasive hysterectomy. They were unable to stratify by variables other than age because data are lacking on characteristics of women who have undergone hysterectomy with morcellation.
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