Uterine Surgery Linked to Cancer Spread

Friday, 07 Feb 2014 04:31 PM

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Doctors across the country are becoming increasingly concerned about the safety of a procedure performed on tens of thousands of women a year in the United States who undergo surgery to remove fibroid tumors from the uterus, or to remove the entire uterus, The New York Times reports.

The procedure, morcellation, is part of minimally invasive surgery, which avoids big incisions, shortens recovery time and reduces the risks of blood loss, infection, and other complications.

Surgeons perform the procedure by hand with a knife, or with an electrical device that has a rapidly spinning blade. But problems have emerged with the procedure, according to two articles published in The Journal of the American Medical Association.

The technique can spray bits of uterine tissue or fibroids around inside the abdomen like seeds. Even benign tissue (fibroids are benign) can take hold and grow on organs, causing pain, infection, or bowel obstruction.

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In a few cases, a rare and hard-to-diagnose uterine tumor called a sarcoma was hidden in the uterus or mistaken for a fibroid, and morcellation apparently spread cancer cells through the patient’s abdomen, leading to cancer.

According to the American College of Obstetricians and Gynecologists, about 498,000 women in the United States had hysterectomies to remove the uterus in 2010, and about 11 percent of those operations involved morcellation.

Kimberly Kho, M.D., an author of one of the journal articles and an assistant professor of obstetrics and gynecology at the University of Texas Southwestern Medical Center, said the technique should not necessarily be banned, because minimally invasive surgery has so many benefits for patients.

"I do think, however, that we could be more prudent and conservative with whom we use these instruments on and more systematic about preoperative evaluation to prevent morcellating detectable cancers," she said.

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