Evidence map›Paper›PMID 26449386›Full record

ArticleJournal of the National Cancer Institute2015

Economic and Survival Implications of Use of Electric Power Morcellation for Hysterectomy for Presumed Benign Gynecologic Disease.

Jason D Wright, Rosa R Cui, Anqi Wang, Ling Chen, Ana I Tergas, William M Burke, Cande V Ananth, June Y Hou, Alfred I Neugut, Sarah M Temkin and 2 more

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of the National Cancer Institute, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
2.8field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 16 citations in OpenAlex.

  1. Article
  2. Association Between Power Morcellation and Mortality in Women With Unexpected Uterine Cancer Undergoing Hysterectomy or Myomectomy.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2019
    Article
  3. Article
  4. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors at 4 institutions in 3 countries.

Jason D Wright: Department of Obstetrics and Gynecology (JDW, RRC, LC, AIT, WMB, CVA, JYH) and Department of Medicine (AIN, DLH), Columbia University College of Physicians and Surgeons; Department of Epidemiology (AIT, CVA, AIN, DLH) and Department of Health Policy and Management (AW, YCW), Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons (JDW, AIT, WMB, JYH, AIN, DLH); New York Presbyterian Hospital, New York, NY (JDW, AIT, WMB, JYH, AIN, DLH); National Cancer Institute, Bethesda, MD (SMT). jw2459@columbia.edu.
Rosa R Cui: Department of Obstetrics and Gynecology (JDW, RRC, LC, AIT, WMB, CVA, JYH) and Department of Medicine (AIN, DLH), Columbia University College of Physicians and Surgeons; Department of Epidemiology (AIT, CVA, AIN, DLH) and Department of Health Policy and Management (AW, YCW), Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons (JDW, AIT, WMB, JYH, AIN, DLH); New York Presbyterian Hospital, New York, NY (JDW, AIT, WMB, JYH, AIN, DLH); National Cancer Institute, Bethesda, MD (SMT).
Anqi Wang: Department of Obstetrics and Gynecology (JDW, RRC, LC, AIT, WMB, CVA, JYH) and Department of Medicine (AIN, DLH), Columbia University College of Physicians and Surgeons; Department of Epidemiology (AIT, CVA, AIN, DLH) and Department of Health Policy and Management (AW, YCW), Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons (JDW, AIT, WMB, JYH, AIN, DLH); New York Presbyterian Hospital, New York, NY (JDW, AIT, WMB, JYH, AIN, DLH); National Cancer Institute, Bethesda, MD (SMT).
Ling Chen: Department of Obstetrics and Gynecology (JDW, RRC, LC, AIT, WMB, CVA, JYH) and Department of Medicine (AIN, DLH), Columbia University College of Physicians and Surgeons; Department of Epidemiology (AIT, CVA, AIN, DLH) and Department of Health Policy and Management (AW, YCW), Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons (JDW, AIT, WMB, JYH, AIN, DLH); New York Presbyterian Hospital, New York, NY (JDW, AIT, WMB, JYH, AIN, DLH); National Cancer Institute, Bethesda, MD (SMT).
Ana I Tergas: Department of Obstetrics and Gynecology (JDW, RRC, LC, AIT, WMB, CVA, JYH) and Department of Medicine (AIN, DLH), Columbia University College of Physicians and Surgeons; Department of Epidemiology (AIT, CVA, AIN, DLH) and Department of Health Policy and Management (AW, YCW), Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons (JDW, AIT, WMB, JYH, AIN, DLH); New York Presbyterian Hospital, New York, NY (JDW, AIT, WMB, JYH, AIN, DLH); National Cancer Institute, Bethesda, MD (SMT).
William M Burke: Department of Obstetrics and Gynecology (JDW, RRC, LC, AIT, WMB, CVA, JYH) and Department of Medicine (AIN, DLH), Columbia University College of Physicians and Surgeons; Department of Epidemiology (AIT, CVA, AIN, DLH) and Department of Health Policy and Management (AW, YCW), Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons (JDW, AIT, WMB, JYH, AIN, DLH); New York Presbyterian Hospital, New York, NY (JDW, AIT, WMB, JYH, AIN, DLH); National Cancer Institute, Bethesda, MD (SMT).
Cande V Ananth: Department of Obstetrics and Gynecology (JDW, RRC, LC, AIT, WMB, CVA, JYH) and Department of Medicine (AIN, DLH), Columbia University College of Physicians and Surgeons; Department of Epidemiology (AIT, CVA, AIN, DLH) and Department of Health Policy and Management (AW, YCW), Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons (JDW, AIT, WMB, JYH, AIN, DLH); New York Presbyterian Hospital, New York, NY (JDW, AIT, WMB, JYH, AIN, DLH); National Cancer Institute, Bethesda, MD (SMT).
June Y Hou: Department of Obstetrics and Gynecology (JDW, RRC, LC, AIT, WMB, CVA, JYH) and Department of Medicine (AIN, DLH), Columbia University College of Physicians and Surgeons; Department of Epidemiology (AIT, CVA, AIN, DLH) and Department of Health Policy and Management (AW, YCW), Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons (JDW, AIT, WMB, JYH, AIN, DLH); New York Presbyterian Hospital, New York, NY (JDW, AIT, WMB, JYH, AIN, DLH); National Cancer Institute, Bethesda, MD (SMT).
Alfred I Neugut: Department of Obstetrics and Gynecology (JDW, RRC, LC, AIT, WMB, CVA, JYH) and Department of Medicine (AIN, DLH), Columbia University College of Physicians and Surgeons; Department of Epidemiology (AIT, CVA, AIN, DLH) and Department of Health Policy and Management (AW, YCW), Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons (JDW, AIT, WMB, JYH, AIN, DLH); New York Presbyterian Hospital, New York, NY (JDW, AIT, WMB, JYH, AIN, DLH); National Cancer Institute, Bethesda, MD (SMT).
Sarah M Temkin: Department of Obstetrics and Gynecology (JDW, RRC, LC, AIT, WMB, CVA, JYH) and Department of Medicine (AIN, DLH), Columbia University College of Physicians and Surgeons; Department of Epidemiology (AIT, CVA, AIN, DLH) and Department of Health Policy and Management (AW, YCW), Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons (JDW, AIT, WMB, JYH, AIN, DLH); New York Presbyterian Hospital, New York, NY (JDW, AIT, WMB, JYH, AIN, DLH); National Cancer Institute, Bethesda, MD (SMT).
Y Claire Wang: Department of Obstetrics and Gynecology (JDW, RRC, LC, AIT, WMB, CVA, JYH) and Department of Medicine (AIN, DLH), Columbia University College of Physicians and Surgeons; Department of Epidemiology (AIT, CVA, AIN, DLH) and Department of Health Policy and Management (AW, YCW), Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons (JDW, AIT, WMB, JYH, AIN, DLH); New York Presbyterian Hospital, New York, NY (JDW, AIT, WMB, JYH, AIN, DLH); National Cancer Institute, Bethesda, MD (SMT).
Dawn L Hershman: Department of Obstetrics and Gynecology (JDW, RRC, LC, AIT, WMB, CVA, JYH) and Department of Medicine (AIN, DLH), Columbia University College of Physicians and Surgeons; Department of Epidemiology (AIT, CVA, AIN, DLH) and Department of Health Policy and Management (AW, YCW), Mailman School of Public Health, Columbia University; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons (JDW, AIT, WMB, JYH, AIN, DLH); New York Presbyterian Hospital, New York, NY (JDW, AIT, WMB, JYH, AIN, DLH); National Cancer Institute, Bethesda, MD (SMT).
Columbia University · USColumbia College · CANewYork–Presbyterian Hospital · USRoyal College of Physicians · GB

Funding

Training Program in Cancer-Related Population SciencesR25CA094061 · NCI · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI NEUGUT, ALFRED I. · 2002 to 2016
$5.9M
The Influence of Hospital Variability on the Management of Cancer-Associated CompR01CA169121 · NCI · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI WRIGHT, JASON · 2013 to 2017
$1.8M
Determinants and risks of use and overuse of expensive oncology drugsR01CA134964 · NCI · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI HERSHMAN, DAWN · 2008 to 2011
$1.0M
NCI NIH HHS R01 CA134964NCI NIH HHS R01CA134964NCI NIH HHS R01 CA169121NCI NIH HHS R01CA169121-01A1NCI NIH HHS R25 CA094061NCI NIH HHS R25 CA094061-11
6 · The paper itself

Abstract

backgroundElectric power morcellation during laparoscopic hysterectomy allows some women to undergo minimally invasive surgery but may disrupt underlying occult malignancies and increase the risk of tumor dissemination.

methodsWe developed a state transition Markov cohort simulation model of the risks and benefits of hysterectomy (abdominal, laparoscopic, and laparoscopic with electric power morcellation) for women with presumed benign gynecologic disease. The model considered perioperative morbidity, mortality, risk of cancer and dissemination, and outcomes in women with an underlying malignancy. We explored the effectiveness from a societal perspective stratified by age (<40, 40-49, 50-59, and ≥60 years).

resultsUnder all scenarios, modeled laparoscopic hysterectomy without morcellation was the most beneficial strategy. Laparoscopic hysterectomy with morcellation was associated with 80.83 more intraoperative complications, 199.64 fewer perioperative complications, and 241.80 fewer readmissions than abdominal hysterectomy per 10 000 women. Per 10 000 women younger than age 40 years, laparoscopic hysterectomy with morcellation was associated with 1.57 more cases of disseminated cancer and 0.97 fewer deaths than abdominal hysterectomy. The excess cases of disseminated cancer per 10 000 women with morcellation compared with abdominal hysterectomy increased with age to 47.54 per 10 000 in women age 60 years and older. Compared with abdominal hysterectomy, this resulted in 0.30 (age 40-49 years), 5.07 (age 50-59 years), and 18.14 (age 60 years and older) excess deaths per 10 000 women in the respective age groups.

conclusionLaparoscopic hysterectomy without morcellation is the most beneficial approach of the three methods of hysterectomy studied. In older women, the risks of electric power morcellation may outweigh the benefits of minimally invasive hysterectomy.

Indexed as

LaparoscopyAdultAgedCost-Benefit AnalysisElectricityFemaleGenital Diseases, FemaleHumansHysterectomyLeiomyomaMiddle AgedSurvival AnalysisUnited StatesUterine Neoplasms

Identifiers

PMID26449386
PMCPMC4849362
OpenAlexW2310967453

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.