Studies Look at Cancer Risks with Hysterectomies Using Morcellation

Two new studies have examined the risk of morcellator hysterectomy complications as the controversy over the medical devices continues. Both studies, which were published in February, looked specifically at whether the morcellators could worsen some types of uterine cancer. The results come on the heels of an FDA announcement last November, warning against the use of morcellators in the large majority of patients undergoing hysterectomies or myomectomies.

About power morcellators

Power morcellators have come into use as a way of performing hysterectomies laparoscopically, rather than through traditional open procedures. Laparoscopic procedures allow for smaller incisions, less post-surgical discomfort and faster recovery times, making them a popular choice for patients and a cost-effective option for insurance companies. In the case of hysterectomies, the morcellator effectively breaks apart the uterus and fibroids so they can be removed through the smaller incision.

However, questions have been raised about whether these devices can worsen an undetected cancer known as uterine sarcoma. While the morcellators are not responsible for causing the sarcoma, they can spread cancer cells throughout the abdominal cavity. When this occurs, the cancer becomes considerably more difficult to treat and the prognosis for the patient becomes significantly more dire.

Studies on morcellation

The first study was conducted by researchers at the University of Michigan and published in the journal Obstetrics and Gynecology. Researchers looked at more than 2,500 women who underwent surgery for fibroids in 2013. The study found that one in every 368 women undergoing hysterectomies for fibroids had undetected uterine sarcoma. This type of cancer can become significantly worse after use of a morcellator, because cells can spread throughout the body and make the cancer much more difficult to treat.

The second study looked specifically at women undergoing fibroid removal using a morcellator without a hysterectomy – a procedure known as a myomectomy. While the study found the risk to be smaller for women undergoing this particular procedure, researchers from the study cautioned that the cancer risk increases with the patient’s age. The study, which was published online by the Journal of the American Medical Association Oncology, warned that uncertainty regarding morcellators should still be considered by both gynecologists and patients.

Controversy grows

Controversy over the reports of morcellator risks have grown, as gynecologists and others have fought against doing away with the devices during all hysterectomies. Last May, the American Association for Laparoscopic Gynecologists (AALG) issued a report in defense of morcellation use, stating the device was safe when used by “experienced, high-volume surgeons.” The influential report has since come under scrutiny as questions have been raised about a possible conflict of interest with one of the authors of the report.

Arnold Advincula, an executive officer for AALG, had received consulting fees from a manufacturer of a morcellator before drafting this report with his colleagues. In fact, a report in the Wall Street Journal suggest Advincula had “sway over the publication.” Concerns like this are not unusual in the medical world, where questions have been raised in other situations where physicians had reviewed a product or device after taking fees from the manufacturer for consulting or other services.

Concerns are now intensified with the deaths of some women following the detection of cancer after morcellation surgery. Some women that have been injured by these devices are now filing lawsuits against the morcellator manufacturers, alleging the risks were not properly spelled out for them prior to their procedures. Even as Johnson & Johnson has stopped selling their morcellator and the FDA has discouraged use of the devices during hysterectomies, morcellators continue to be used, leaving many guessing that studies and litigation over this issue are far from over.

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