Key clinical point: Morcellation during hysterectomy in patients with incidental uterine sarcoma may cause impaired survival. Among Norwegian women with undiagnosed uterine sarcomas, the 10-year age-adjusted survival after morcellation was 32.2% compared with 57.2% without morcellation, yielding an age-adjusted hazard ratio of 1.9.

Major finding: The risk of dying from uterine sarcoma after morcellation was 1.5 per 1000 procedures. Sarcoma mortality was higher among women who underwent morcellation (age-adjusted HR 1.90, CI 1.05–3.44; multivariate HR, 2.50, 95% CI 0.57–10.9). Age-adjusted 10-year uterine sarcoma survival was 32.2% for women treated with morcellation compared with 57.2% for those who did not undergo morcellation (difference 25.5%; CI −55.7 to 18.1). All-cause 10-year survival was 32.2% in the morcellated group and 44.1% in the non-morcellated group (difference 11.9%; CI −40.9 to 32.7).

Study details: A study of 653 patients with uterine sarcoma diagnosed after 1991 when vaginal and laparoscopic hysterectomies were introduced in Norway; 23 (3.5%) of them underwent morcellation. Uterine sarcoma prevalence was 3.6 per 1000 laparoscopic hysterectomies.

Disclosures: The authors disclosed no financial conflicts.

Source: Bretthauer M et al. European Journal of Cancer; 2018, 62-68 https://doi.org/10.1016/j.ejca.2018.06.007