Hysterectomy Procedure Tied to Worse Cancer Outcomes

Women who must have their uterus removed should be wary of a procedure called uncontained uterine power morcellation, Yale University researchers warn, according to a report published Sept. 16 in the Journal of Clinical Oncology.

This once common surgical option for hysterectomy or myomectomy (removal of uterine fibroids) has been linked to worse outcomes for patients with undiagnosed uterine cancer at the time of surgery.

In a hysterectomy, the procedure uses an electric device -- a morcellator -- to break up and remove the uterus through a small cut in the abdomen. The worry is that the rotating blade of the device may spread cancer cells into the abdomen. The U.S. Food and Drug Administration issued a warning on this technique in 2014.

"Hysterectomy and myomectomy are very common procedures. A large number of women undergo these surgeries each year, so it is very important to ensure patient safety during these procedures," said lead author Xiao Xu, an associate professor of obstetrics, gynecology and reproductive sciences at Yale.

For the study, Xu and her team collected New York State data on hysterectomies and myomectomies performed between 2003 and 2013. Using cancer registry data through 2015, they identified women with undiagnosed uterine cancer when they underwent their surgery.

Among the women who later learned they had cancer, uncontained power morcellation was tied to a greater risk of dying. This was especially so for those with leiomyosarcoma -- a rare, aggressive type of uterine cancer, the study found.

The researchers also found that the procedure made it harder to diagnose the cancer, thereby making it more difficult to treat it.

"For patients at higher risk for uterine cancer, such as postmenopausal women, it may be helpful to avoid uncontained power morcellation if possible," Xu said in a Yale news release.

However, the procedure should not be totally discounted, she said. Because it is less invasive than surgery, it has fewer complications and may be useful for younger women who have only a slight risk of uterine cancer.

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