For women who want to remove symptomatic uterine fibroids, power morcellation has been a popular option over the past 10 years.
But the technique, which involves using a rotating power blade to slice tumors into strips that can then be removed with a small incision, has been the subject of great controversy since Massachusetts anesthesiologist Amy Reed had the procedure in 2013 to remove her uterus (another use for the technique) and subsequently developed late-stage cancer throughout her abdomen. Reed and her heart-surgeon husband Hooman Noochashm launched a public campaign against power morcellation.
Studies since have shown that power morcellation may cause benign tissue to implant in the abdominal cavity, but the question of whether it can cause cancerous tumors to spread has not been answered. The Food and Drug Administration (FDA) issued a nonbinding warning on the procedure in April but has not yet issued a ruling. Some hospitals have tightened rules for using power morcellation, but most still perform the procedure.
In the meantime, many women have questions about the technique. We talked with Dr. Charles Drescher, a gynecological oncologist at Swedish Medical Center and a researcher at Fred Hutchinson Cancer Research Center, to get the latest answers.
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What is power morcellation?
It’s a procedure to reduce a fibroid tumor from a large mass into multiple smaller masses so that it can be removed by small-incision laparoscopy instead of major surgery. A device with a rotating blade slices the tumor and a hollow tube in the center of the device is used to remove it from the body.
What are the advantages and disadvantages of using it?
The advantage is that it’s a less invasive procedure than traditional surgery, which means a faster recovery time (from 10 days to two weeks, as opposed to three to four weeks for major surgery), less blood loss and less need for pain medicine.
The disadvantage is that it may cause small benign tumors to form in the abdominal cavity, or in rare cases when a tumor thought to be a fibroid is actually cancerous, to spread cancer.
How likely is it that a presumed fibroid will turn out to be cancerous?
Unfortunately, preoperative testing can’t say definitively whether a tumor is a fibroid tumor (which is benign) or a cancerous one called a leiomyosarcoma. Fibroids are very common, but the cancerous tumors are rare, though not as rare as they were once thought to be.
A 2014 study published in the Journal of the American Medical Association found malignancies in 1 of 368 women whose tumors were removed by power morcellation. Originally, the number was thought to be much lower. About 68 percent of the cancerous tumors were found in women over 50.
If a tumor is malignant, how likely is it that power morcellation will spread the cancer?
The answer is completely unknown at this point. Leiomyosarcomas have been found in the abdominal cavity of some women like Reed after power morcellation. Usually, these tumors are found in the pelvis, lungs or liver, not the abdominal cavity, making the procedure a focus of suspicion.
When leiomyosarcomas are removed through traditional surgery, there is an over 60 percent chance of recurrence. Is power morcellation adding to their number, or just changing the pattern of occurrence of a few of them? We don’t know.
Postmenopausal women and women whose tumors are growing rapidly have higher risk factors for malignancy, and thus are not good candidates. Younger women with stable or slow-growing tumors may decide to use the procedure after being informed of risks.
What’s the alternative?
Many fibroids can be managed without removal, but if removal is indicated and power morcellation isn’t a good option, women may undergo traditional surgery. The risk of infection and other complications is low — about 3 to 6 percent — though not as low as surgical laparoscopy’s 1 to 3 percent. Recovery time is longer.
Are there any other treatments on the horizon?
A few doctors have experimented with power morcellation using an inflatable plastic bag to collect the tumor. It’s a very new procedure, and there is no data yet on whether it is effective.
Teresa Meek is a Seattle freelance writer and editor. Her work has appeared in The Miami Herald, Newsday, the St. Petersburg Times and the Baltimore Sun.