Some institutions and groups defining stances on morcellation

March 1, 2014

Some societies and institutions are developing formal policies on morcellation in response to an increase in public concern over the possibility of this procedure spreading and upstaging undetected cancer in the uterus.

 

The story of a physician in Boston who is undergoing treatment for uterine cancer that may have been spread by morcellation has been picked up by the popular press. News outlets including The Wall Street Journal, ABC News, USA Today, and The New York Times have published stories about cancer patient Amy Reed, MD, PhD, and her husband, Hooman Noorchashm, MD, PhD, who in response to his wife’s illness has begun a campaign urging a moratorium on uterine morcellation. His change.org petition had garnered more than 5000 signatures as of late February.

In response to these stories and the resulting increase in public concern over the possibility of this procedure spreading and upstaging undetected cancer, some societies and institutions are developing formal policies on morcellation.

In December 2013, the Society of Gynecologic Oncology (SGO) issued a statement that said in part, “[morcellation] is generally contraindicated in the presence of documented or highly suspected malignancy, and may be inadvisable in premalignant conditions or risk-reducing surgery.”

It went on to recommend that “patients … who might require intracorporeal morcellation should be appropriately evaluated for the possibility of coexisting uterine or cervical malignancy” while acknowledging that currently no reliable method exists to differentiate benign from malignant leiomyomas.

The morcellation debate: The science, the facts, the future

According to The Wall Street Journal, Temple University Hospital in Philadelphia recently set limits on morcellation. Doctors there are being told to perform hysterectomies as conservatively as possible, and open procedures are required for uterine sizes larger than 18 weeks. Three Boston-area hospitals and the Cleveland Clinic are also reviewing or creating policies regarding morcellation and doctors are being told to spell out the potential risks to patients, The Wall Street Journal reports.

The American College of Obstetricians and Gynecologists (ACOG) has not issued new guidelines for its members concerning morcellation, but says, “ACOG recently conducted a preliminary review of the literature on morcellation, and the findings are consistent with … the clinical guidance contained in existing ACOG Practice Bulletins and Committee Opinions. As ACOG updates its guidelines, we will further consider any newly available information and incorporate it at that time.”

Jon I. Einarsson, MD, PhD, MPH, Deputy Editor of Contemporary OB/GYN and the director of the division of minimally invasive gynecologic surgery at Brigham and Women’s Hospital, Boston, anticipates changes ahead in how morcellation is performed. “Electromechanical morcellation has enabled gynecologists to offer patients a minimally invasive approach for specimen extraction for over 2 decades,” he noted. “However, morcellation in its current form has drawbacks that have been highlighted by recent events. I believe that in the next few years, open electromechanical morcellation will be a thing of the past.

“Novel methods of enclosed specimen extraction are already being developed and will probably come to market within the next 2 to 3 years. I predict that this disruptive technology will dramatically change our methods for specimen extraction moving forward."

The morcellation debate: The science, the facts, the future