Objective
Electric morcellation of uterine fibroids at laparoscopy may cause intraperitoneal dissemination of occult leiomyosarcomas, with worsening of the already poor prognosis. According to the Food and Drug Administration (FDA) this may occur in 1/498 (0.2%) procedures. Therefore, myoma morcellation is being stringently restricted. However, age is a risk factor and the peak incidence of leiomyosarcomas is >50 years. Thus, populations undergoing myomectomy or hysterectomy should be considered separately. Our aim was to define the prevalence of unexpected leiomyosarcomas in a large series of myomectomies.
Study design
The databases of our center were searched to determine the number of myomectomies performed at laparoscopy or laparotomy in a 15-year period (January 1999 through December 2013). Pathology reports were reviewed and cross-checked with those of our gynecologic oncology service. The objective was definition of the prevalence of leiomyosarcomas and tumors with atypical features not detected preoperatively.
Study design
The databases of our center were searched to determine the number of myomectomies performed at laparoscopy or laparotomy in a 15-year period (January 1999 through December 2013). Pathology reports were reviewed and cross-checked with those of our gynecologic oncology service. The objective was definition of the prevalence of leiomyosarcomas and tumors with atypical features not detected preoperatively.
Results
Myomectomies were performed in 2356 women with a mean ± SD age of 39 ± 6 years, at laparoscopy in 1388 cases and at laparotomy in 968. From 2008 through 2013, only one third of patients (388/1205) underwent myomectomy at laparotomy ( Figure ). All fibroids removed endoscopically were morcellated. We observed 1 case of leiomyosarcoma in a 39-year-old woman with an 8-cm tumor, and 1 case of smooth muscle tumor of uncertain malignant potential (STUMP) in a 47-year-old woman with a 9-cm lesion. Both women underwent a laparoscopic procedure. The proportion of leiomyosarcoma was 0.04% (95% confidence interval, <0.01–0.27%). Considering also the STUMP case, the proportion of unexpected tumors was 0.08% (95% confidence interval, <0.01–0.33%). The patient with the sarcoma died 4 months after the myomectomy, whereas the patient with STUMP is free of disease at 2-year follow-up.
