An Occult Invasive Cervical Cancer Found After a Simple Hysterectomy: A 10-Year Experience in a Single Institution

Suh, Dong Hoon; Chung, Hyun Hoon; Kim, Jae Weon; Park, Noh Hyun; Song, Yong Sang; Kang, Soon Beom

doi:10.1097/igc.0b013e3182272d0a

Cited by 5 publications

(3 citation statements)

References 25 publications

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“…However, these data might be underestimated to some extent, because RP and partial vaginectomy were not performed in our series. Several previous studies had similar results [ 16 , 35 , 39 ]. Thus, this patient group might benefit from conservative treatment, such as simple observation.…”

Section: Discussionsupporting

confidence: 75%

“…OICC has mainly been attributed to inadequate preoperative workup. Its reported incidence was as high as 12.9 % several decades ago [ 33 , 34 ], but it has significantly dropped to 2.7 % from 6.4 % in more recent studies [ 14 , 16 , 35 ] and was 1.9 % in the present series. This improvement is possibly because of the development of improved screening technologies that can better detect cervical cancer, and an enhanced awareness in both patients and doctors about disease prevention.…”

Section: Discussioncontrasting

confidence: 61%

“…The relatively high morbidity rates were mainly attributed to the difficulty of administering RP after SH because of the paucity of tissue that can be removed during the operation [ 15 ]. The success of this procedure largely depends on the surgeon’s experience and skill [ 8 , 35 ]. The rate of serious late complications associated with RT or CCRT in our series was as high as 27 %, which was in agreement with the results described in Park’s report [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

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Occult invasive cervical cancer after simple hysterectomy: a multi-center retrospective study of 89 cases

et al. 2016

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BackgroundOccult invasive cervical cancer (OICC) is sometimes incidentally found in surgical specimens after a simple hysterectomy (SH). This study was aimed at identifying a subset of patients with OICC who have a favorable prognosis. This patient group may not require adjuvant radiotherapy and other procedures.MethodsThe medical records of women in whom OICC was detected after an inadvertent SH were retrospectively reviewed. The relevant data, including clinicopathological characteristics, treatment and clinical outcome were evaluated. The primary and secondary endpoints were overall survival (OS) and relapse-free survival (RFS), respectively.ResultsEighty-nine patients who met the inclusion criteria were included for analysis, and the risk of OICC was found to be 1.9 %. Finding an invasive cancer in a hysterectomy specimen after a conization procedure that shows positive margins was the most common reason (41.6 %) for the performance of inadvertent SH. In the univariate analysis, a tumor width > 20 mm, deep stromal invasion, and lymph node metastasis (LNM) were adversely associated with relapse (P < 0.001, < 0.001, and = 0.001, respectively) and survival (P = 0.003, 0.004, and 0.027, respectively), although these parameters were not independently associated with patient prognoses in the multivariate analysis. In patients with a tumor width ≤ 20 mm and superficial stromal invasion in the observation subgroup, the 5-year RFS and 5-year OS were both 100 %, whereas they were 57.1 % and 66.7 %, respectively, in patients with a tumor size > 20 mm and deep stromal invasion in the radiotherapy or chemotherapy subgroup (P < 0.001, and = 0.008, respectively).ConclusionsSimple observation after a lymphadenectomy procedure may be feasible in OICC patients with a tumor width ≤ 20 mm, superficial stromal invasion, a negative section margin in hysterectomy specimens, and no LNM.

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Section: Discussionsupporting

confidence: 75%

Section: Discussioncontrasting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

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Occult invasive cervical cancer after simple hysterectomy: a multi-center retrospective study of 89 cases

et al. 2016

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Is salvage radiotherapy optimal to patients with occult cervical cancer undergoing inadvertent simple hysterectomy? A propensity score-matched analysis of a nationwide clinical oncology database

Wang

Ouyang

et al. 2020

Japanese Journal of Clinical Oncology

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Objective We used National Cancer Institute’s Surveillance, Epidemiology and End Result database to assess the role of salvage radiotherapy for women with unanticipated cervical cancer after simple hysterectomy. Methods Patients with non-metastatic cervical cancer and meeting inclusion criteria were divided into three groups based on treatment strategy: simple hysterectomy, salvage radiotherapy after hysterectomy and radical surgery. Parallel propensity score-matched datasets were established for salvage radiotherapy group vs. simple hysterectomy group (matching ratio 1: 1), and salvage radiotherapy group vs. radical surgery group (matching ratio 1:2). The primary endpoint was the overall survival advantage of salvage radiotherapy over simple hysterectomy or radical surgery within the propensity score-matched datasets. Results In total, 2682 patients were recruited: 647 in the simple hysterectomy group, 564 in the salvage radiotherapy group and 1471 in the radical surgery group. Age, race, histology, grade, FIGO stage, insured and marital status and chemotherapy were comprised in propensity score-matched. Matching resulted in two comparison groups with neglectable differences in most variables, except for black race, FIGO stage III and chemotherapy in first matching. In the matched analysis for salvage radiotherapy vs. simple hysterectomy, the median follow-up time was 39 versus 32 months. In the matched analysis for salvage radiotherapy vs. radical surgery, the median follow-up time was 39 and 41 months, respectively. Salvage radiotherapy (HR 0.53, P = 0.046) significantly improved overall survival compared with simple hysterectomy, while salvage radiotherapy cannot achieve similar overall survival to radical surgery (HR 1.317, P = 0.045). Conclusions This is the largest study of the effect of salvage radiotherapy on overall survival in patients with unanticipated cervical cancer. Salvage radiotherapy can improve overall survival compared with hysterectomy alone, while cannot achieve comparable survival to radical surgery.

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Problems associated with inadequate surgery in patients with cervical cancer

Verma¹,

Srivastava²,

Singhal³

et al. 2022

Cancer Research, Statistics, and Treatment

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An Occult Invasive Cervical Cancer Found After a Simple Hysterectomy: A 10-Year Experience in a Single Institution

Abstract: Adjuvant treatment can be omitted in low-risk group patients with invasive cervical cancer detected after SH.

Cited by 5 publications

References 25 publications

Occult invasive cervical cancer after simple hysterectomy: a multi-center retrospective study of 89 cases

Occult invasive cervical cancer after simple hysterectomy: a multi-center retrospective study of 89 cases

Is salvage radiotherapy optimal to patients with occult cervical cancer undergoing inadvertent simple hysterectomy? A propensity score-matched analysis of a nationwide clinical oncology database

Problems associated with inadequate surgery in patients with cervical cancer

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