abstract
OBJECTIVE::
To define the incidence of unexpected gynecologic malignancies among women who underwent hysterectomy for benign indications.
METHODS::
We
conducted a data analysis of hysterectomy cases from a quality and
safety database maintained by the Michigan Surgical Quality
Collaborative, a statewide group of hospitals that voluntarily reports
perioperative outcomes. Cases were abstracted from January 1, 2013,
through December 8, 2013. Benign preoperative surgical indications
included pelvic mass, family history of cancer, hyperplasia without
atypia, prolapse, endometriosis, pelvic pain, abnormal uterine bleeding,
or leiomyomas. Women with a surgical indication of cancer, cervical
dysplasia, or hyperplasia with atypia were excluded.
RESULTS::
During
the study period, 7,499 women underwent a hysterectomy and 85.24%
(n=6,360) were performed for benign indications. The incidence of
unexpected gynecologic malignancy among hysterectomies performed for
benign indications was 2.7% (n=172) and included ovarian, peritoneal,
and fallopian tube cancer (n=69 [1.08%]), endometrial cancer (n=65
[1.02%]), uterine sarcoma (n=14 [0.22%]), metastatic cancer (n=13
[0.20%]), and cervical cancer (n=11 [0.17%]). The most common
indications for hysterectomy were leiomyomas and abnormal uterine
bleeding. There was no difference in the mean age (46.86±10.57 compared
with 47.0±10.76 years, P=.96) of women with unexpected sarcoma compared
with benign disease. Women with unexpected sarcoma were more likely to
have a history of venous thromboembolism and preoperative blood
transfusion, but this did not reach statistical significance.
CONCLUSION::
The
2.7% incidence of unexpected gynecologic malignancy includes a 0.22%
incidence of uterine sarcoma and 1.02% incidence of endometrial cancer.
No reliable predictors of uterine sarcoma exist and caution is warranted
in preoperative planning for hysterectomy. LEVEL OF EVIDENCE:: II.
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