Disseminated leiomyoma cells can be identified following conventional myomectomy

• Published in: BJOG : an international journal of obstetrics and gynaecology Vol. 123; no. 13; pp. 2183 - 2187
• Main Authors: Sandberg, EM, Haak, L, Bosse, T, Jansen, FW
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-12-2016
• Subjects: Abdomen; Abdominal surgery; Adult; Cells; Cytology; Female; Fibroids; Gynecology; Humans; Laparoscopic myomectomy; Laparoscopy; Leiomyoma - pathology; Leiomyoma - surgery; morcellation; Neoplasm Seeding; Neoplastic Cells, Circulating; Peritoneum; Surgery; tissue dissemination; Tumors; Uterine Myomectomy - adverse effects; Uterine Myomectomy - methods; Uterine Neoplasms - pathology; Uterine Neoplasms - surgery; tissue dissemination; Laparoscopic myomectomy; morcellation
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/1471-0528.14265

Objective
Uncontained morcellation of leiomyomas during laparoscopic surgery has recently been discouraged, as undetected malignant tumours, namely leiomyosarcomas, could be fragmented which may result in upstaged disease. However, enucleating leiomyomas per se may be inappropriate from an oncological perspective because complete, radical resection of malignant tumours to prevent further tumour growth or recurrence is not achieved. Thus, the aim of this study was to determine whether spillage of leiomyoma cells occurs during laparotomic myomectomy.
Design
Observational study.
Setting
Tertiary academic centre in the Netherlands.
Population
Women undergoing laparotomic myomectomy were included in the study.
Methods
Peritoneal abdominal washings were obtained on two occasions during the myomectomy procedure; the first one immediately after opening the abdomen and the second one after resection of the leiomyoma(s). Cytological evaluation of the fluids was performed.
Main outcome measures
The presence of leiomyoma cells in any of the washings.
Results
Five patients were included in this pilot study. All first washings were negative for leiomyoma cells. However, cytology positive for the presence of leiomyoma cells was found in three of the five second, post‐myomectomy washings.
Conclusion
Tissue spillage from leiomyoma(s) occurs during conventional open myomectomy. The clinical relevance of tissue dissemination after myomectomy is unclear but it cannot be excluded that this may negatively affect the patient's outcome if there is malignant change within the enucleated leiomyoma(s). Therefore, it is questionable whether morcellation in specially designed containment bags after laparoscopic myomectomy, guarantees any additional oncological safety.
Tweetable
Even during conventional myomectomy, tissue spillage occurs during resection of leiomyoma(s).
Tweetable
Even during conventional myomectomy, tissue spillage occurs during resection of leiomyoma(s).