Mesa doctor takes flak on controversial technique
A Mesa doctor who touted the removal via laparoscopic surgery of a large, “world record” ovarian tumor has drawn the ire of a fellow physician who is warning women against that type of surgery.
Dr. Gregory Marchand used a variation of a surgical technique called “morcellation” to remove a large ovarian tumor from a Mesa woman. The surgical technique involves using a laparoscope to slice a tumor into small bits and remove it through small incisions.
The technique has proven controversial because if the sliced tissue is cancerous, it can spread dangerous cancer cells to other parts of the body. That could significantly worsen a per-
son’s chances of surviving an aggressive form of cancer.
Government studies have shown a risk of spreading undetected cancerous cells in one out of 350 women who undergo a hysterectomy or uterine-fibroid removal. The Food and Drug Administration has therefore recommended against using the drill-like power morcellator device to remove uterine tissue.
However, Marchand contends the operation he publicized earlier this year — one in which he removed a 17-centimeter ovarian tumor from a patient using morcellation —was safe because he did not use a power morcellator. Marchand instead sliced the tumor into bits by hand.
Marchand said he also used a containment bag to collect the minced bits of tumor before they could spread inside the patient’s body, minimizing the risk that the cellular matter could spread.
After Marchand performed the surgery in 2015, he said the cancer that was removed was “staged” by a gynecologic oncologist who collected and tested tissue samples that suggested the cancer had not spread beyond the woman’s ovaries.
Marchand’s staff later researched published medical literature and claimed that the cancerous tumor was the largest ever removed through a small incision.
Marchand initially sought recognition from Guinness World Records as a world record for that type of surgery, but the organization said the claimed achievement was too specific. He then turned to an organization called World Record Academy, which researched and recognized the surgery as the largest cancerous tumor removed through the technique.
Marchand’s staff issued a press release about the surgery in January. The initial notice did not attract much media attention, so Marchand again sent out a press release in July. Some television news stations aired segments on the surgery after the second release.
Marchand’s press releases and subsequent television news reports about the surgery caught the attention of Hooman Noorchashm, a Philadelphia-area cardiac surgeon who has waged relentless battle against the use of morcellation since 2013.
That’s when his late wife, Dr. Amy Reed, underwent a procedure to have her uterus removed because of fibroids, but she was unaware that the doctors used a power morcellator to slice and remove the tissue. A biopsy confirmed she had an aggressive form of uterine cancer, which was likely spread through morcellation.
Reed filed the first adverse-event report with the FDA in December 2013, and the couple urged a ban on the device for gynecologic procedures. The FDA studied the issue and in 2014 recommended the surgical device not be used on most women undergoing a hysterectomy or removal of uterine fibroids.
Reed died in May, but Noorchashm continues to raise awareness about the risks of the surgical technique. He zeroed in on Marchand’s surgery in critical pieces that appeared on the social-media website Medium on Aug. 7 and Oct. 25.
Following the most recent post, Noorchashm said he was contacted by Medium and asked to remove references to Marchand. So the pieces only identify Marchand as “Dr. M.”
In his most recent post, Noorchashm said that Dr. M. made “reckless marketing claims in the popular press, which I know pose a danger to unsuspecting women.”
Marchand responds that the criticism leveled by Noorchashm is off-base.
“I am not pleased,” Marchand said. “I just don’t think he understands gynecologic surgery very well.”
Marchand said that of more than 400 gynecologic morcellations performed, post-surgical biopsies revealed three cases of cancer.
He said he only performs such procedures on gynecologic tissue that the American Congress of Obstetricians and Gynecologists criteria suggest has a low chance of being cancerous.
Marchand said he agrees with his chief critic on one point — that morcellation should not be used on patients with a known cancer.
“Nobody is advocating morcellation on any mass that is known to be cancerous,” Marchand said.
But he said he believes manual morcellation with a containment bag can appeal to some patients.