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European Society of Gynecological Oncology Statement on Fibroid and Uterine Morcellation

Halaska, MJ; Haidopoulos, D; Guyon, F; Morice, P; Zapardiel, I; Kesic, V; Cibula, D; ... Laky, R; + view all (2017) European Society of Gynecological Oncology Statement on Fibroid and Uterine Morcellation. International Journal of Gynecological Cancer , 27 (1) pp. 189-192. 10.1097/IGC.0000000000000911. Green open access

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Abstract

Recently, there has been an intense discussion about the issue of fibroid and uterine morcellation in relation to the risk of unrecognized uterine sarcoma spread. Morcellation can negatively influence the prognosis of patients, and transecting the specimen into pieces prevents the pathologist from performing proper disease staging. Many societies have published their statements regarding this issue. The European Society for Gynecological Oncology has established a working group of clinicians involved in diagnostics and treatment of oncogynecological patients to provide a statement from the oncological point of view. Leiomyosarcomas and undifferentiated endometrial sarcomas have generally dismal prognosis, whereas low-grade endometrial stromal sarcomas and adenosarcomas have variable prognosis based on their stage. A focus on the detection of patients at risk of having a sarcoma should be mandatory before every surgery where morcellation is planned by evaluation of risk factors (African American descent, previous pelvic irradiation, use of tamoxifen, rapid lesion growth particularly in postmenopausal patients) and exclusion of patients with any suspicious ultrasonographic signs. Preoperative endometrial biopsy should be mandatory, although the sensitivity to detect sarcomas is low. An indication for myomectomy should be used only in patients with pregnancy plans; otherwise en bloc hysterectomy is preferred in both symptomatic and postmenopausal patients. Eliminating the technique of morcellation could lead to an increased morbidity in low-risk patients; therefore, after thorough preoperative evaluation and discussion with patients, morcellation still has its place in the armamentarium of gynecologic surgery.

Type: Article
Title: European Society of Gynecological Oncology Statement on Fibroid and Uterine Morcellation
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/IGC.0000000000000911
Publisher version: http://doi.org/10.1097/IGC.0000000000000911
Language: English
Additional information: Copyright © 2016 by IGCS and ESGO. This is a non-final version of an article published in final form in Halaska, MJ; Haidopoulos, D; Guyon, F; Morice, P; Zapardiel, I; Kesic, V; Cibula, D; (2017) European Society of Gynecological Oncology Statement on Fibroid and Uterine Morcellation. International Journal of Gynecological Cancer , 27 (1) pp. 189-192. 10.1097/IGC.0000000000000911.
Keywords: Uterine sarcoma, Leiomyosarcoma, European Society of Gynecological Oncology, Statement, Power morcellation, Prognosis
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute > CRUK Cancer Trials Centre
URI: https://discovery.ucl.ac.uk/id/eprint/1540883
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