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

Abstract

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, Kruskal- Wallis 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.