Correspondence

SGO not soft on morcellation: risks and benefits must be weighed As President of the Society of Gynecologic Oncology (SGO), I am writing in response to your leader in the February, 2014, issue of The Lancet Oncology, in which you discuss SGO’s position statement on intracorporeal uterine morcellation.1 By contrast with your assertion that SGO has taken a “soft” position, we state quite explicitly the circumstances in which it is contraindicated; specifically, “in the presence of documented or highly suspected malignancy” and possibly “in premalignant conditions or riskreducing surgery”.2 This, we feel, is hardly a soft stance. In many cases, morcellation allows a procedure that would have needed an exploratory laparotomy to be done via minimally invasive methods, and thus substantially decreases the morbidity of the procedure. In particular, blood transfusion, surgical site infection, venous thrombosis, length of hospital admission, and post-operative pain are reduced with minimally invasive surgery, and quality of life and time to return to baseline function are improved. Weighing the risk of these common and sometimes deadly complications to the 0·1–0·25% risk that morcellating a fibroid uterus will result in spread of a leiomyosarcoma should be considered, especially given that these sarcomas have a very poor prognosis even if they are removed intact. We are deeply saddened to learn about the Harvard physician diagnosed with leiomyosarcoma. This is a rare and tragic disease. Unfortunately, it is not possible to confirm the presence of this disease before surgery. It falls to us as surgeons to examine the evidence and assess available options for each individual woman. www.thelancet.com/oncology Vol 15 April 2014

We have no definitive scientific evidence for whether one procedure is safer than another. Although you say that “the attitude prevails that new and expensive equipment must be an advance”, we have to make calculated decisions on a daily basis as to whether we choose to adopt new technologies. We certainly agree that all medical devices should be adequately assessed for safety before they become adopted by providers. In the vast majority of cases, hysterectomy is done because of the presence of benign uterine fibroids. In these circumstances, intracorporeal morcellation has benefited hundreds of thousands of women. It is especially beneficial for obese women. It would be a disservice to deny these women this option. I am the President of the Society of Gynecologic Oncology.

Barbara A Goff barbara.goff@sgo.org Society of Gynecologic Oncology, Chicago, IL 60606, USA 1

2

The Lancet Oncology. Patient safety must be a priority in all aspects of care. Lancet Oncol 2014; 15: 123. Society of Gynecologic Oncology. Position statement on morcellation, December, 2013. https://www.sgo.org/newsroom/positionstatements-2/morcellation/ (accessed on March 17, 2014).

Afatinib in NSCLC harbouring EGFR mutations We read with interest the results of the LUX-Lung 6 trial1 that compared efficacy and safety of first-line afatinib with cisplatin plus gemcitabine in 364 Asian patients with advanced non-small-cell lung cancer (NSCLC) harbouring EGFR mutations. The results showed that afatinib led to significantly longer median progression-free survival (PFS) than did cisplatin plus gemcitabine (11·0 months vs 5·6 months; HR 0·28 [95% CI 0·20–0·39]; p

SGO not soft on morcellation: risks and benefits must be weighed.

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