Sarcoma Risk in Uterine Surgery in a Tertiary University Hospital in Germany.

OBJECTIVES: There is a risk to incidentally spread uterine malignancies, especially sarcoma, if tissue is morcellated during hysterectomy or myoma enucleation. In the last years, a worldwide discussion has been started about this problem. However, the risk seems to be very small in recent studies. This study aims at further investigating the risk of disseminating uterine malignancy during uterine surgery in a tertiary university hospital in Germany.

METHODS: In a retrospective setting, all cases of uterine myometrial surgery (hysterectomies and myomectomies) in our clinic during a period of 10 years were identified using clinical databases. Histology was linked and searched for uterine malignancies. All cases were reviewed for incidental morcellation of malignant tissue.

RESULTS: Between 2004 and 2014, we identified 2825 cases of uterine myometrial surgery. Morcellating procedures were used in 20% of the 1402 hysterectomy procedures (280/1402) and in 13.7% of the 1423 fibroid removals (195/1423). We identified 23 uterine mesenchymal malignancies (sarcoma, n = 10; carcinosarcoma, n = 13). In 3 cases, there was no evidence or sign of a malignant disease preoperatively in a procedure with a morcellation (vaginal hysterectomy with morcellation, n = 1; open fibroid enucleation, n = 2).

CONCLUSIONS: A small risk (0.35% [1/280]) of accidental morcellation during hysterectomy with morcellation was found in our study. We did not observe an occult case of sarcoma after myomectomy with morcellation (0/195), but we found 2 cases of accidental sarcoma after myomectomy without morcellation. For these reasons, minimally invasive surgery with morcellation should not be excluded a priori. The patient should be well informed about the risks and various options. The advantage of laparoscopic surgery should be balanced against the risk of the unknown spread of malignant tissue.