Recognition of the role morcellation plays in disseminating tumor tissue throughout the abdomen may have implications for management of ULMS; for one thing, it represents a change in the usual way that ULMS tumors spread in the body.4

As demonstrated by Oduyebo and colleagues, immediate surgical re-exploration to facilitate accurate staging of ULMS that are identified after morcellation leads to upstaging in about one of four women and should be considered so that optimal treatment can be designed and delivered.


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Although it is unlikely that motorized morcellation will be abandoned, many hospitals and professional societies are responding to the increased recognition of its risks by advocating for improving informed consent, research into safer alternatives, and modifications to reduce the risk of dissemination.

The Society of Gynecologic Oncology (SGO) issued a statement in December 2013 contraindicating morcellation in patients with documented or suspected malignancy and recommending that women being considered for the procedure be fully evaluated for the possible presence of malignant disease.

The SGO also advocates for full and transparent communication between oncologists and patients, so women can make informed decisions about the risks and benefits of this form of treatment.9

References

  1. Seidman MA, Oduyebo T, Muto MG, et al. Peritoneal dissemination complicating morcellation of uterine mesenchymal neoplasms. PLoS One. 2012;7(11):e50058.
  2. Hampton T. Critics of fibroid removal procedure question risks it may pose for women with undetected uterine cancer. JAMA. 2014;311(9):891-893.
  3. Kho KA, Nezhat CH. Evaluating the risks of electric uterine morcellation. JAMA. 2014; 311(9):905-906 4. Oduyebo T, Rauh-Hain AJ, Meserve EE, et al. The value of re-exploration in patients with inadvertently morcellated uterine sarcoma. Gynecol Oncol. 2014;132:360-365.
  4. American Cancer Society. Uterine sarcoma. http://www.cancer.org/acs/groups/cid/documents/webcontent/003145-pdf. Accessed February 11, 2014.
  5. Rauh-Hain JA, Oduyebo T, Diver EJ, et al. Uterine leiomyosarcoma: an updated series. Int J Gynecol Cancer. 2013;23(6):1036-1043.
  6. Park JY, Park SK, Kim DY, et al. The impact of tumor morcellation during surgery on the prognosis of patients with apparently early uterine leiomyosarcoma. Gynecol Oncol. 2011;122(2):255-259.
  7. Perri T, Korach J, Sadetzki S, et al. Uterine leiomyosarcoma: does the primary surgical procedure matter? Int J Gynecol Cancer. 2009;19(2):257-260.
  8. Society of Gynecologic Oncology. Morcellation. December 2013. https://www.sgo.org/newsroom/position-statements-2/morcellation/. Accessed February 12, 2014.