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Dr. Max Gomez: Pelvic Cancer And The Risk/Reward Of The Morcellator

Experts At Odds Over Device That Provides Minimally Invasive Surgery

CBS New York (con't)

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NEW YORK (CBSNewYork) – There’s a new warning about a common surgery that tens of thousands of women have every year.

As CBS 2’s Dr. Max Gomez explains, new information shows the device could actually spread undetected cancer.

Stage 4 leiomyosarcoma is medical jargon for advanced pelvic cancer. It’s the last thing Amy Reed thought she’d be dealing with six months after having uterine fibroids removed.

“It was very hard initially … the level of anxiety is horrible,” Reed said.

Reed had laparoscopic surgery to remove the tumors using a device called a morcellator, which shreds the tissue so it can be removed through the small, minimally invasive incisions.

What she and her doctors did not know is that she had cancer in the wall of her uterus and morcellation made a bad situation much worse.

“If you cut the tumor in pieces inside of the abdomen, there is the potential of spread of the cancer throughout the abdomen, so that makes the stage of the cancer more advanced,” said Dr. Enrique Hernandez of Temple University Hospital.

Something similar happened to Brenda Leuzzi.

“Nobody wants to hear, you’ve got 12 months left to live, or less,” she said.

Brenda had hemorrhaged several times from large uterine fibroids and she opted for the same laparoscopic surgery with morcellation.

“They took a tumor that was at a low stage and morcellated her and now she’s at a high stage,” said husband George Leuzzi.

The risk of spreading a pre-existing cancer with morcellation is concerning enough that the Food and Drug Administration has issued an advisory that “discourages the use of laparoscopic power morcellation during hysterectomy or myomectomy for uterine fibroids.”

But it turns out it’s not quite so straightforward.

“Clearly not every case should be morcellated, however to not morcellate anybody would be a tragic error because many women will benefit from minimally invasive surgery,” Dr. Steve R. Goldstein said.

Goldstein is a professor of OB-GYN at NYU Langone Medical Center and a past president of a number of GYN societies. He said it is possible to tell when it’s safe to use a morcellator.

“I may not be able to definitively say that something is cancer, but I can often definitively say that something is not,” Dr. Goldstein said.

Dr. Kathy Huang, the chief of robotic surgery at NYU-Langone, said that minimally invasive surgery reduces many of the complications of open surgery for fibroids.

“Such as blood loss, infection, blood clots which could also be lethal and the recovery time for minimally invasive surgery is significantly shorter,” Dr. Huang said.

There are ways to tell a fibroid may be malignant: a special type of MRI, blood flow sonograms, age, rate of growth of the fibroid and so on that allow doctors to determine whether it’s safe to morcellate.

The key is to individualize the approach for each patient.

Dr. Gomez said NYU and several OB-GYN societies have said the morcellator should continue to be used in the right cases.

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