Mesa doc­tor takes flak on con­tro­ver­sial tech­nique

The Arizona Republic - - Front Page - Ken All­tucker

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.

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