Association Between Power Morcellation and Mortality in Women With Unexpected Uterine Cancer Undergoing Hysterectomy or Myomectomy
| Autor: | Francis P. Boscoe, Jason D. Wright, Lindsey M. Hutchison, Xiao Xu, Peter E. Schwartz, Cary P. Gross, Haiqun Lin, Vrunda B. Desai |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Cancer Research medicine.medical_specialty medicine.medical_treatment Morcellation Hysterectomy 03 medical and health sciences 0302 clinical medicine Uterine cancer Uterine Myomectomy medicine Humans Survival rate Aged 030219 obstetrics & reproductive medicine business.industry Obstetrics Case-control study Follow up studies Sarcoma ORIGINAL REPORTS Middle Aged medicine.disease Prognosis Occult Endometrial Neoplasms Survival Rate Oncology 030220 oncology & carcinogenesis Case-Control Studies Uterine Neoplasms Female business Follow-Up Studies |
| Zdroj: | J Clin Oncol |
| ISSN: | 1527-7755 |
| Popis: | PURPOSE Despite concerns that power morcellation may adversely affect prognosis of patients with occult uterine cancer, empirical evidence has been limited and inconclusive. In this study, we aimed to determine whether uncontained power morcellation at the time of hysterectomy or myomectomy is associated with increased mortality risk in women with occult uterine cancer. METHODS By linking statewide hospital discharge records with cancer registry data in New York, we identified 843 women with occult endometrial carcinoma and 334 women with occult uterine sarcoma who underwent a hysterectomy or myomectomy for presumed benign indications during the period October 1, 2003, through December 31, 2013. Within this cohort, we compared disease-specific and all-cause mortality of women who underwent laparoscopic supracervical hysterectomy/laparoscopic myomectomy (LSH/LM), a surrogate indicator for uncontained power morcellation, with women who underwent supracervical abdominal hysterectomy and total abdominal hysterectomy (TAH), which did not involve power morcellation. Multivariable Cox regressions and propensity score method were used to adjust for patient characteristics. RESULTS Among women with occult uterine sarcoma, LSH/LM was associated with a higher risk for disease-specific mortality than TAH (adjusted hazard ratio [aHR], 2.66, 95% CI, 1.11 to 6.37; adjusted difference in 5-year disease-specific survival, −19.4%, 95% CI, −35.8% to −3.1%). In the subset of women with leiomyosarcoma, LSH/LM was associated with an increased risk for disease-specific mortality compared with supracervical abdominal hysterectomy (aHR, 3.64, 95% CI, 1.50 to 8.86; adjusted difference in 5-year disease-specific survival, −31.2%, 95% CI, −50.0% to −12.3%) and TAH (aHR, 4.66, 95% CI, 1.97 to 11.00; adjusted difference in 5-year disease-specific survival, −37.3%, 95% CI, −54.2% to −20.3%). Among women with occult endometrial carcinoma, there was no significant association between surgical approach and disease-specific mortality. CONCLUSION Uncontained power morcellation was associated with higher mortality risk in women with occult uterine sarcoma, especially in those with occult leiomyosarcoma. |
| Databáze: | OpenAIRE |
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