Comparison of Survival Outcomes in Women with Unsuspected Uterine Malignancy Diagnosed After Laparotomic Versus Laparoscopic Myomectomy: A National, Population-Based Study

Purpose The primary objective of our study was to investigate the effect of morcellation on overall survival in women with unsuspected uterine malignancy (UUM) diagnosed after myomectomy by comparing women who underwent laparotomic myomectomy to those who underwent laparoscopic myomectomy. The secondary objective was to estimate the incidence of UUM diagnosed after myomectomy. Methods We analyzed the mortality and incidence of women with UUM diagnosed after myomectomy using data from the national health insurance database between 2009 and 2013. To extract women with or without UUM diagnosed after myomectomy, we used diagnosis (C54.X) and procedure codes. We used the indicator of suspicion of death to verify deaths. Results During the study period, among the study population of approximately 23 million women per year, 102144 women underwent myomectomy. Of them, 69955 and 32085 women were enrolled onto the laparotomic and laparoscopic groups, respectively. In each group, the numbers of women with UUM diagnosed after myomectomy were 76 and 50, respectively. The incidences of UUM and UUM excluding endometrial cancer, respectively, were 0.1, 0.15 % ( p = 0.046) and 0.05, 0.07 % ( p = 0.147) in each group, respectively. The overall 3-year survival rates for patients with UUM and UUM excluding endometrial cancer were 97.6 ± 0.2 % ( n = 23), 91.5 ± 0.5 % ( n = 12); and 93.8 ± 0.6 % ( n = 8), 93.8 ± 0.6 % ( n = 5) in each group, respectively. Additionally, there were no statistically significant differences between the groups with respect to overall survival of women with UUM with or without endometrial cancer (log-rank test; p = 0.14) (time-dependent Cox regression model; p = 0.93). Conclusions There was no difference in the overall survival of women with UUM with or without endometrial cancer between groups. The incidence of UUM with or without endometrial cancer diagnosed after myomectomy was quite low.