Likelihood of incidental finding of gynecological cancer in women undergoing hysterectomy for benign indications

Objective: The aim of this study was to determine the incidence of unexpected gynecological malignancy (UGM) after hysterectomy performed for benign indications. Methods: We analysed patient sample data extracted from a medical database between 1 January 2007 and 10 August 2019 for 2740 women who underwent a hysterectomy for benign indications. The Kolmogorov-Smirnov test, KruskalWallis test and Chi-square test were performed. Statistical significance was reached if p < 0.05. Results : The most common primary indications for hysterectomy were leiomyomata (1403, 51%), abnormal uterine bleeding (784, 28.61%), and pelvic organ prolapse (504, 18.39%). A laparotomic, laparoscopic or vaginal hysterectomy was performed in 1452 (53%), 836 (30.5%) and 452 (16.5%) women, respectively. unexpected gynecological malignancy after hysterectomy was diagnosed in 22 (0.80%) women. The incidence of unexpected uterine malignancies (UUM), unexpected endometrial cancer, and unexpected uterine malignancies without endometrial cancer was 0.54%, 0.40% and 0.14% respectively. Mean ages were not significantly different for abdominal, laparoscopic and vaginal hysterectomy groups (51.75 ± 9.83, 51.32 ± 9.51, 51.39 ± 10.04 years respectively, p = 0.299). No significant difference in the incidence of unexpected gynecological malignancy was noted between the groups [laparotomy 0.47%, laparoscopy 0.22%, vaginal 0.11%, p = 0.066]. The incidence of unexpected leiomyosarcoma [laparatomic 0.11%, laparascopic 0.03%, vaginal 0.0%] and unexpected endometrial carcinoma [laparatomic 0.26%, laparascopic 0.11%, vaginal 0.03%] was significantly higher in abdominal and laparascopic hysterectomy groups than the vaginal hysterectomy group and no significant difference was observed between the abdominal and laparoscopic hysterectomy groups (p = 0.037, p = 0.028, p = 0.108, respectively). Conclusion: The incidence of unexpected gynecological malignancy diagnosed after hysterectomy performed for benign conditions was very low, if the correct indications were selected.

[1]  M. Hacker,et al.  Hysterectomy Practice Patterns in the Postmorcellation Era. , 2019, Obstetrics and Gynecology.

[2]  A. Weaver,et al.  Incidence of sarcoma in patients undergoing hysterectomy for benign indications: a population‐based study , 2019, American journal of obstetrics and gynecology.

[3]  Committee Opinion No. 701 Summary: Choosing The Route Of Hysterectomy For Benign Disease. , 2017, Obstetrics and gynecology.

[4]  Yanting Wang,et al.  Incidence of Occult Uterine Pathology in Women Undergoing Hysterectomy With Pelvic Organ Prolapse Repair , 2016, Female pelvic medicine & reconstructive surgery.

[5]  B. Mol,et al.  The accuracy of endometrial sampling in women with postmenopausal bleeding: a systematic review and meta-analysis. , 2016, European journal of obstetrics, gynecology, and reproductive biology.

[6]  PhD Jin-Sung Yuk MD,et al.  The Incidence of Unexpected Uterine Malignancy in Women Undergoing Hysterectomy for a Benign Condition: A National Population-Based Study , 2016, Annals of Surgical Oncology.

[7]  G. Kilic,et al.  A medical-legal review of power morcellation in the face of the recent FDA warning and litigation. , 2015, Journal of minimally invasive gynecology.

[8]  X. Guo,et al.  Alterations in surgical technique after FDA statement on power morcellation. , 2015, American journal of obstetrics and gynecology.

[9]  B. Quade,et al.  The role of endometrial biopsy in the preoperative detection of uterine leiomyosarcoma , 2015 .

[10]  S. As-Sanie,et al.  Unexpected Gynecologic Malignancy Diagnosed After Hysterectomy Performed for Benign Indications , 2015, Obstetrics and gynecology.

[11]  C. Ananth,et al.  Uterine Pathology in Women Undergoing Minimally Invasive Hysterectomy Using Morcellation , 2014 .

[12]  C. Nezhat,et al.  Evaluating the risks of electric uterine morcellation. , 2014, JAMA.

[13]  L. Lowenstein,et al.  Incidence of unanticipated uterine pathology at the time of minimally invasive abdominal sacrocolpopexy. , 2014, Journal of minimally invasive gynecology.

[14]  H. Marret,et al.  Risk of incidental finding of endometrial cancer at the time of hysterectomy for benign condition. , 2014, Journal of minimally invasive gynecology.

[15]  M. Leitao,et al.  Comparison of robotic and laparoscopic hysterectomy for benign gynecologic disease. , 2014, Obstetrics and gynecology.

[16]  L. Wilkens,et al.  Cancer incidence trends among Asian American populations in the United States, 1990-2008. , 2013, Journal of the National Cancer Institute.

[17]  T. Krivak,et al.  Occult uterine cancer in patients undergoing laparoscopic hysterectomy with morcellation: Implications for surveillance for disease recurrence and outcomes , 2013 .

[18]  T. Chung,et al.  Risk of malignancy in women who underwent hysterectomy for uterine prolapse , 2013, The Australian & New Zealand journal of obstetrics & gynaecology.

[19]  Alexander Schellong,et al.  Unexpected malignancies after laparoscopic-assisted supracervical hysterectomies (LASH): an analysis of 1,584 LASH cases , 2013, Archives of Gynecology and Obstetrics.

[20]  K. Kenton,et al.  Utility of preoperative endometrial assessment in asymptomatic women undergoing hysterectomy for pelvic floor dysfunction , 2012, International Urogynecology Journal.

[21]  Sun-Kyung Park,et al.  The impact of tumor morcellation during surgery on the prognosis of patients with apparently early uterine leiomyosarcoma. , 2011, Gynecologic oncology.

[22]  M. Barber,et al.  Risk of unanticipated abnormal gynecologic pathology at the time of hysterectomy for uterovaginal prolapse. , 2010, American journal of obstetrics and gynecology.

[23]  R. M. Etchebehere,et al.  Gynecological malignant neoplasias diagnosed after hysterectomy performed for leiomyoma in a university hospital. , 2010, European journal of gynaecological oncology.

[24]  B. Mol,et al.  Surgical approach to hysterectomy for benign gynaecological disease (Review) , 2009 .

[25]  D. Riethmuller,et al.  [Hysterectomies performed for presumed leiomyomas: should the fear of leiomyosarcoma make us apprehend non laparotomic surgical routes?]. , 2009, Gynecologie, obstetrique & fertilite.

[26]  ACOG Committee Opinion No. 444: choosing the route of hysterectomy for benign disease. , 2009, Obstetrics and gynecology.

[27]  Mitsuaki Suzuki,et al.  Risk of Complications and Uterine Malignancies in Women Undergoing Hysterectomy for Presumed Benign Leiomyomas , 1999, Gynecologic and Obstetric Investigation.

[28]  E. Wight,et al.  Electrical cutting device for laparoscopic removal of tissue from the abdominal cavity , 1993, Obstetrics and gynecology.

[29]  D. Mishell,et al.  Leiomyosarcoma in a series of hysterectomies performed for presumed uterine leiomyomas. , 1990, American journal of obstetrics and gynecology.