New Study Shows Morcellator Hysterectomy Can Lead to Uterine Cancer

A new study published in the Journal of the American Medical Association (JAMA) on Tuesday, July 22nd, showed a link between laparoscopic morcellator hysterectomy procedures and uterine cancer.

In April this year, the Food and Drug Administration advised surgeons to stop using morcellators to remove uterine fibroids, as some of the fibroids could actually be tumors. Removing the tumors with a morcellator can cause cancer to spread faster. On July 11th, the FDA announced that it would create an investigative panel to look into the safety of laparoscopic power morcellators, devices commonly used in fibroid removal surgery.

Now, the latest study, conducted by Columbia University doctors, found that 1 in 368 women who undergo a morcellator hysterectomy  have undetected uterine cancer and are at risk of having that cancer spread to other organ systems.

Laparoscopic morcellators allow for tiny incisions in the abdomen, rather than more open surgery, reducing recovery time in the hospital. Surgeons use the morcellator devices to cut up fibroids, or the uterus itself in the case of a morcellator hysterectomy, and remove the tissue through the small incisions.

The study’s authors used a database funded by the National Cancer Institute that had insurance information from more than 36,000 women who were treated with power morcellators at over 500 US hospitals over a period of 7 years. The study included all cases of women who had uterine cancer after they underwent a morcellator hysterectomy procedure, including endometrial cancer, which is more common than uterine cancer.

“Certainly that is the next step, to answer those questions,” said Jason D. Wright, the lead author of the report and director of gynecologic oncology at the Columbia University College of Physicians and Surgeons. “I think this provides important information showing that there is certainly a risk of cancer, not only sarcomas, but endometrial cancer at the time of morcellation.”

Not only were cancerous uterine sarcomas missed – the tumors can often look like simple fibroid tissue – but other gynecological cancers, as well as precancerous tissue, were missed in pre-surgical screenings.

Morcellation is supposed to be a simple, non-invasive procedure in which the laparoscopic device is used to find fibroid tissue in the uterus, and grind fibroids down to be removed through a small incision in the abdomen. Uterine fibroids can cause pain and annoyance with menstruation, so many women choose to undergo the surgery to reduce those complications. Proponents of the device say that the device allows for less invasive surgery, which can prevent many post-surgical complications and allows for shorter recovery time for the patient. Opponents, however, say that fibroid removal and, sometimes, hysterectomies are elective surgeries and using power morcellators is too risky.

Dr. Wright added that, although power morcellators were approved for use by the FDA in the 1990’s and have been on the market for two decades, little research has been conducted into their actual safety and effectiveness as surgical tools.

“I’ve been seeing women harmed by this thing for the last eight years,” said Dr. Robert Lamparter, a pathologist at a small Pennsylvania hospital. He recently wrote a letter to the FDA requesting the device’s clearance be revoked because of the dangers it poses. He said he has analyzed tissue in five cases in which an unanticipated cancer was morcellated.

“I’m just horrified,” Lamparter said in an interview. “It’s not just another complication. There is no acceptable injury or death rate for an elective surgical device, even if it’s wonderful for those who aren’t harmed.”

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