Six-year survival of patients with unsuspected uterine malignancy after laparoscopic versus laparotomic myomectomy: An 11-year national retrospective cohort study

Objective. The primary objective was to compare the overall survival of women with unsuspected uterine malignancy (UUM), including sarcomas and adenosarcomas, diagnosed after laparotomic versus laparoscopic myomectomy. The secondary objective was to determine the incidence of UUM diagnosed after myomectomy. Methods. We analyzed the national health insurance database, which covers almost the entire Korean population, between 2006 and 2010 to calculate the incidence and mortality of UUM diagnosed after myomectomy. Diagnosis and procedure codes were used to identify women with or without UUM. Results. During the study period, 78,826 patients who underwent myomectomy among women in the database (23 million per year) were enrolled. The women were divided into a laparotomic myomectomy group (n = 56,213) and a laparoscopic myomectomy group (n = 22,613). The incidence of UUM diagnosed after myomectomy was 0.08% in both groups (47/56,213 and 18/22,613 women, respectively). There was no difference in mean age, socioeconomic status, diagnostic code, UUM incidence at 5-year intervals, survival rate, or mean survival time. The 5-year survival rates of women with UUM were 95.7% and 88.9% in the laparotomic and laparoscopic groups, respectively. A Kaplan-Meier survival analysis showed no difference in the overall survival rates according to the surgical method (P = 0.447). Conclusions. The incidence of UUM after myomectomy was 0.08% after laparotomic or laparoscopic myomectomy. Although morcellator use does not reduce the overall survival rate, clinicians should explain the risks of intraperitoneal tumor dissemination to patients and do their best to prevent tumor spillage when using this tool. (C) 2018 Elsevier Inc. All rights reserved.