Is There a Need for Pre-Operative Evaluation in an Asymptomatic Patient Population Receiving a Supracervical Hysterectomy?
Arun Gopinath, Srinivas Mandavilli, Margaret Assaad, Adam C Steinberg. Hartford Hospital, CT
Background: In the United States approximately 550,000 hysterectomies are performed annually with the vast majority done for benign conditions. With the advent of minimally invasive techniques (laparoscopy and robotically assisted laparoscopy), supracervical hysterectomy (SCH)has gained popularity. Urogynecology performs SCH as part of their pelvic reconstruction to decrease the risk of potential complications. Debate has occurred whether in the asymptomatic patient,evaluation (ultrasound,endometrial biopsy) for potential of endometrial pathology is warranted. Urogynecology at our institution does not perform an evaluation in the asymptomatic patients. The aim of this study is:1) find the incidence of incidental uterine carcinoma in SCH specimens 2) evaluate the need for preoperative gynecological workup in asymptomatic patients.
Design: Following IRB approval, the pathologic findings in all SCH performed (October 2006-September 2009) in our institution were analyzed. Two groups were established for comparison,procedures performed by 3 urogynecologists(groupI) vs 29 general gynecologists (groupII). Procedures performed by Gynecology-oncology were excluded from the study.
Results: 320 (groupI-86 and groupII-234) subjects were included. Mean age of groupI-53.7 (27-77yrs) when compared to group2-45.1 (26-65yrs) demonstrated a difference (p<.001).82 subjects,all in group2, had pre operative endometrial biopsies interpreted at our hospital. In groupII, 1 high grade adenocarcinoma and 1 complex atypical hyperplasia were identified compared to none in groupI (statistically not significant). Other findings in both groups included complex hyperplasia without atypia (1, 0.3%), chronic endometritis (1, 0.3%), benign endometrial polyp (21, 6.5%), leiomyomas (204, 64 %),adenomyosis (113, 35%) and adenomatoid tumor (1, 0.3%).
Conclusions: In patients receiving supracervical hysterectomy the incidence of carcinoma is very low. In this study no significant difference was identifiable between patients who had some form of evaluation and those who did not. This could be attributed to the fact that, in the patients with abnormal findings on preoperative evaluation referral to the gynecology-oncology surgeons occurred. We conclude that with the probability of occult uterine malignancy being very low the need for expensive preoperative evaluation in an asymptomatic population needs to be questioned.
Category: Gynecologic & Obstetrics
Wednesday, March 2, 2011 1:00 PM
Poster Session VI # 139, Wednesday Afternoon