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

Abstract

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.

Extraperitoneal pelvic lymph node dissection with laparotomy in occult invasive cervical cancer found after a simple hysterectomy

“…OICC primarily results from insufficient preoperative examination. The development of improved screening technologies and enhanced awareness in both patients and doctors regarding disease prevention possibly contributed to the decrease in incidence [1,2]. The most common causes of inadvertent simple hysterectomy were the lack of preoperative Pap smear, negative cytology, followed by insufficient evaluation of an abnormal Pap smear or cervical biopsy, and failure to carry out conization or endocervical curettage [18,19].…”

“…Cervical cancer can be incidentally diagnosed after simple hysterectomy performed for preinvasive cervical lesions or benign gynecologic conditions. The incidence of occult invasive cervical cancer (OICC) is between 2.7 % and 1.9 % according to recent reports [1,2]. If a cervical lesion is not microinvasive, a simple hysterectomy (SH) procedure is suboptimal and related to undesired poor survival rates [3].…”

“…If a cervical lesion is not microinvasive, a simple hysterectomy (SH) procedure is suboptimal and related to undesired poor survival rates [3]. At present, radical parametrectomy (RP) and partial vaginectomy with pelvic lymphadenectomy, or adjuvant radiotherapy (RT) with or without chemotherapy (CT) are the most preferred treatment approaches for OICC following SH [2]. There are three main risk factor groups including, high-risk, intermediate-risk, and low-risk used in the classification of this disease.…”

“…High-risk factors include pelvic lymph node metastasis, parametrial invasion, and positive surgical resection margin (SM), and intermediate-risk factors include large tumor size, deep stromal invasion, and lymphovascular space invasion (LVSI) [4]. Small volume (≤ 2 cm) tumors with other favorable factors are considered low-risk factors [2].…”

Mexican consensus about surgical treatment in early-stage cervicouterine cancer

“…), histology subtype and tumor characteristics to choose the best treatment. Subgroup analyses suggest observation may suffice for select patients, but this warrants further study ( 47 , 48 ).…”