Morcellation for myomectomy or hysterectomy RCOG consent 2019 Flashcards
In the UK how many cases of gynaecological sarcoma are Dx each year?
400
Risk of unexpected Leiomyosarcomas in <50years (premenopausal)
2.5 per 1000, 1 in 400
Risk of unexpected Leiomyosarcomas in >50years (postmenopausal)
6 per 1000, 1 in 166
May be even high >60 year 1 in 65
What is the age of peak incidence of sarcoma?
50-55
Before consideration of morcellation what imaging should be performed?
USS and MRI, although cannot exclude sarcomatous change
If concerns for uterine sarcoma, what should be done?
If concern e.g. rapidly enlarging mass, then morcellation or breaching of fibroid capsule should not be undertaken
Refer to MDT, hysterectomy recommended
Via which routes can morcellation be perfromed?
Vaginal, laparoscopic or open
Most often performed vaignal or laparoscopic - risk quotes the same
Benefits of lap/vaginal mocellation myomectomy?
Small incision, less pain, reduced risk of infection, reduced risk VTE, shorter hospital stay and quicker recovery
What are the serious risk of lap/vaginal mocellation myomectomy?
1) Unintended morcellation of uterine sarcoma
2) Worsening the prognosis of an existing sarcoma - disseminated sarcoma into pelvis
3) Disseminated fibroids (presence of benign fibroids within the abdominal cavity)
4) Damage to bowel, bladder, ureter blood vessels
Median survival of metastatic sarcoma?
18 months
Age adjusted 10 year uterine survival for morcellated vs non morcellated group?
Morcellated 32%
Non morcellayed 58%
Risk of Disseminated fibroids (presence of benign fibroids within the abdominal cavity)
1/120- 1/1200
Altnerative treatments to discuss
Open myomectomy
Hysterectomy
Uterine artery embolisation
Medical Tx
No Tx
