麻豆传媒

Cervical excision after prior supracervical hysterectomy led to a high complication rate, particularly bleeding, according to a retrospective review of more than 1,000 cases.

Complications occurred in 38% of the procedures, including bleeding in 26% and gastrointestinal complications in 8%. Additionally, 15% of patients required transfusions. More than a third of the procedures were for leiomyomas, and almost 20% involved malignancies, including cervical cancer.

"The risks reported here exceed the expected complication rates of total laparoscopic or abdominal hysterectomy, with more than one third of women experiencing any complication," Stephanie L. Wethington, MD, of Johns Hopkins School of Medicine in Baltimore, and co-authors reported in .

"In most cases, the indication for excision of the retained cervix after supracervical hysterectomy was for leiomyomas or cyclic bleeding, also common indications for total hysterectomy...Overall, excision of the retained cervix is a procedure with relatively high morbidity," the team said. "Patient counseling regarding removal of the cervix at the time of hysterectomy should include this information."

Supracervical hysterectomy accounts for about . Extrapolating that percentage to the , an estimated 1.4 million women in the U.S. have undergone supracervical hysterectomy, the authors noted.

Proponents of supracervical hysterectomy cite evidence of improved sexual and urinary function and decreased operative complexity as compared with total hysterectomy, Wethington and colleagues continued. Meta-analyses, however, the purported advantages.

Knowledge about the outcomes with supracervical hysterectomy and risks associated with repeat surgical intervention remains incomplete. Retention of the cervix entails a future risk of malignancy and recurrence of cyclic bleeding and pelvic pain.

To address the lack of current information, the authors searched the (NIS) for 2010-2014 to identify patients who underwent excision of the retained cervix after supracervical hysterectomy.

The primary objective of the analysis was to determine the overall rate of surgical complications associated with excision of retained cervix, as well as rates of specific types of complications.

The NIS query resulted in 1,140 cases for the analysis. The patients had a mean age of 48.5, Caucasians accounted for 56.5% of the cohort, and the most common indications for excision of the retained cervix were leiomyomas (35.3%), prolapse (13.6%), and bleeding (10.3%).

Additionally, 5.3% of patients had endometriosis, 5.7% had uterine cancer, 4.4% had cervical cancer, 3.5% had ovarian cancer, and 3.5% had other malignancies.

The 38.1% overall perioperative complication rate included the following types of complications:

• Bleeding 25.7% (transfusion in 15.2%, anemia in 15.3%)

• Cardiac and thromboembolic 4.4%

• Gastrointestinal 8.3% (ileus 7.0%)

• Genitourinary and neurologic 3.9%

• Infection 6.4%

• Pulmonary 6.1%

Analysis of procedural characteristics showed that 88.5% of the cases were performed through an abdominal or vaginal approach and the rest by robotic-assisted or laparoscopic techniques. Median length of stay was 2 days for robotic-assisted/laparoscopic procedures and 3 days for abdominal/vaginal cases.

Based on data from a nationally representative sample of patients, the study contributed new information about the rates and types of complications associated with excision of retained cervix after prior hysterectomy, said Kristen Matteson, MD, of Warren Alpert Medical School of Brown University in Providence, Rhode Island.

Clinicians can use the information in counseling patients who express interest in retaining their cervix at the time of hysterectomy.

"Although needing additional surgery in the future to remove the cervix is rare, it is a difficult surgery associated with complications and need for blood transfusion," said Matteson, who is an author of the .

"I was not surprised by these findings," she told 麻豆传媒 via email. "Given the relationship between vital structures near the uterus and the cervix, it was not that surprising that excision of the cervix after supracervical hysterectomy is associated with a high risk of bleeding ... and other complications."

Comment