Effects of Morcellation of Uterine Smooth Muscle Tumor of Uncertain Malignant Potential and Endometrial Stromal Sarcoma: Case Series and Recommendations for Clinical Practice

Mowers, Erika L.; Skinner, Bethany; McLean, Karen; Reynolds, R. Kevin

doi:10.1016/j.jmig.2015.01.007

Cited by 47 publications

(44 citation statements)

References 24 publications

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“…19,59 Giventhedifficultyinpathologicevaluation and likelihood of tumor dissemination, surgical restaging is recommended after inadvertent morcellation of a malignancy to ensure complete resection of residual peritoneal disease. 58,60 The risk of cancer upstaging from peritoneal dissemination in morcellation ranges from 50% to 64% at surgical restaging surgery. 31,58 In an examination of 14 morcellated cases of uterine mesenchymal tumors (including 7 leiomyosarcomas, 1 endometrial stromal sarcoma, 4 STUMPs, 1 atypical leiomyoma, and 1 cellular leiomyoma), 9 showed peritoneal dissemination(64.3%)atsurgical reexploration, including 4 of the 7 patients with leiomyosarcoma.…”

Section: Risk Of Dissemination and Upstaging With Morcellationmentioning

confidence: 99%

“…31 Reported outcomes following surgical reexploration after morcellation of STUMPs 31,61 vary from peritoneal dissemination of STUMP 6 to benign peritoneal implants. 60 …”

Section: Risk Of Dissemination and Upstaging With Morcellationmentioning

confidence: 99%

“…Despite the more indolent course of endometrial stromal sarcomas, similar adverse effects of morcellation are also observed. 60,64 In an evaluation of low-grade endometrial stromal sarcomas, Park et al 64 reported significantly higher rates of abdominopelvic recurrence and worse 5-year disease-free survival among women who underwent morcellation as compared with TAH. No significant differences were observed in 5-yearoverallsurvival.…”

Section: Morcellation and Its Impact On Survivalmentioning

confidence: 99%

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Risk of Occult Uterine Sarcoma in Presumed Uterine Fibroids

Cui

Wright

2016

Clinical Obstetrics &Amp; Gynecology

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Symptomatic fibroids are a common indication for hysterectomy or myomectomy. Although rare, unexpected gynecologic malignancies in presumed fibroids have been documented. In cases where tissue retrieval is performed through morcellation, there is increasing concern that intra-abdominal dispersion of occult uterine malignancies may lead to peritoneal dissemination and worse outcomes. We examined the available literature to determine the prevalence of all uterine cancers in women undergoing hysterectomy or myomectomy for benign uterine disease, with attention to the risk of morcellating occult uterine sarcomas. We also reviewed the available tools for preoperative discrimination between benign and malignant uterine disease.

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Section: Risk Of Dissemination and Upstaging With Morcellationmentioning

confidence: 99%

“…31 Reported outcomes following surgical reexploration after morcellation of STUMPs 31,61 vary from peritoneal dissemination of STUMP 6 to benign peritoneal implants. 60 …”

Section: Risk Of Dissemination and Upstaging With Morcellationmentioning

confidence: 99%

Section: Morcellation and Its Impact On Survivalmentioning

confidence: 99%

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Risk of Occult Uterine Sarcoma in Presumed Uterine Fibroids

Cui

Wright

2016

Clinical Obstetrics &Amp; Gynecology

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“…16 Uterine sarcomas are usually diagnosed incidentally by postoperative histopathology. 17 Although no reliable method is currently available to preoperatively detect or differentiate between myoma and uterine sarcoma, 18,19 preoperative evaluation remains critical, especially for perimenopausal patients.…”

Section: Preoperative Evaluationmentioning

confidence: 99%

Clinical Characteristics and Prognosis of Unexpected Uterine Sarcoma After Hysterectomy for Presumed Myoma With and Without Transvaginal Scalpel Morcellation

Zhang

et al. 2016

International Journal of Gynecological Cancer

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“…7–11 Of greater concern is the dissemination of unsuspected malignancy, which may result in upstaging and decreased survival. 16–18 …”

Section: Introductionmentioning

confidence: 99%

Power Morcellation Using a Contained Bag System

Steller¹,

Cholkeri-Singh

Sasaki

et al. 2017

JSLS

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Background and Objectives:The well-known advantages of minimally invasive surgery make the approach well suited for hysterectomy and other gynecological procedures. The removal of specimens excised during surgery has been a challenge that has been answered by the use of power morcellation. With this study we sought to assess the feasibility of power morcellation within a specimen bag.Methods:This was a retrospective cohort study including patients from a private practice in suburban Chicago, Illinois, who underwent contained electromechanical power morcellation during a laparoscopic or robot-assisted hysterectomy or myomectomy from May 2014 through December 2015. Contained power morcellation was performed with the Espiner EcoSac 230 (Espiner Medical Ltd., North Somerset, United Kingdom) specimen bag. Descriptive statistics were performed for both categorical and continuous data.Results:Of the 187 procedures performed, 73.8% were myomectomies, and 26.2% were hysterectomies. The patients' mean age was 40 (range, 25–54) years and mean body mass index was 28.7 (range, 17.3–57.6). The average specimen weight was 300 g, with the largest weighing 2134 g. Estimated blood loss averaged 98.4 mL. The postoperative admission rate was 12.3%, most of which were due to nausea and urinary retention. Seventeen patients (9.1%) had postoperative complications, most of which were minor, and 4 (2.1%) were readmitted. There were no bag failures or complications that were due to the use of the specimen bag or to power morcellation.Conclusions:Performing electromechanical power morcellation within the Espiner EcoSac 230 specimen bag was successfully performed in 187 patients with no bag-related complications. This method of contained power morcellation is feasible, reliable, and reproducible, even for a large specimen.

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Effects of Morcellation of Uterine Smooth Muscle Tumor of Uncertain Malignant Potential and Endometrial Stromal Sarcoma: Case Series and Recommendations for Clinical Practice

Cited by 47 publications

References 24 publications

Risk of Occult Uterine Sarcoma in Presumed Uterine Fibroids

Risk of Occult Uterine Sarcoma in Presumed Uterine Fibroids

Clinical Characteristics and Prognosis of Unexpected Uterine Sarcoma After Hysterectomy for Presumed Myoma With and Without Transvaginal Scalpel Morcellation

Power Morcellation Using a Contained Bag System

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