The Risk of Primary Uterine and Cervical Cancer After Hysteropexy. Issue 3 (March 2021)

• Record Type: Journal Article
• Authors: Kurian, Rebecca; Kirchhoff-Rowald, Amelia; Sahil, Suman; Cheng, An-Lin; Wang, Xi; Shepherd, Jonathan P.; Sutkin, Gary
• Is Part Of: Female pelvic medicine & reconstructive surgery. Volume 27:Issue 3(2021)
• Page Start: e493
• Page End: e496
• Publication Date: 2021-03
• Subjects: pelvic organ prolapse -- hysteropexy -- endometrial cancer -- endometrial hyperplasia -- cervical cancer; Pelvis -- Diseases -- Periodicals; Pelvis -- Surgery -- Periodicals; Genital Diseases, Female -- surgery -- Periodicals; Urologic Diseases -- surgery -- Periodicals; Colonic Diseases -- surgery -- Periodicals; Rectal Diseases -- surgery -- Periodicals; Surgical Procedures, Operative -- methods -- Periodicals; 616.6
• DOI: 10.1097/SPV.0000000000001030
• Languages: English
• ISSNs: 2151-8378

Abstract

Abstract : Supplemental digital content is available in the text. Abstract : Objective: The aim of the study was to determine the rate of subsequent uterine/cervical cancer after hysteropexy compared with hysterectomy with apical prolapse repair. Methods: The study used a retrospective cohort of women with uterovaginal prolapse using the Cerner Health Facts database between 2010 and 2018. We identified sacrospinous or uterosacral ligament suspensions or sacral colpopexy/hysteropexy and excluded those with previous hysterectomy. We used the International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes for endometrial cancer/hyperplasia and cervical cancer and then reviewed each case, excluding those whose cancer existed at time of prolapse repair. Given that 0 cancer cases were identified, we used Wilson, Jeffreys, Agresti-Coull, Clopper-Pearson, and Rule of 3 to define 95% confidence intervals to estimate the highest possible rate of cancer in each cohort. Results: A total of 8, 927 patients underwent apical prolapse surgery. Of 4, 510 with uterovaginal prolapse, 755 (16.7%) underwent hysteropexy. Seventy one with hysterectomy and 5 with hysteropexy had codes for subsequent gynecologic cancer but were excluded on further review. This left 0 gynecologic cancer cases with the largest 95% confidence interval of 0%–0.61% for hysteropexy versus 0%–0.13% for hysterectomy ( P > 0.05). The hysteropexy cohort was older (62.6 years vs 57.3 years, P < 0.0001), more likely to have public insurance (51.0% vs 37.9%, P < 0.0001), and less likely to smoke (4.5% vs 7.6%, P = 0.0026). Median follow-up was longer after hysteropexy (1, 480 days vs 1, 164 days, P < 0.0009). Conclusions: We can say with 95% certainty that uterine or cervical cancer will develop after hysteropexy in fewer than 0.61% of women, which was not different if hysterectomy was performed. This should be included in preoperative counseling for hysteropexy. Studying longer follow-up after hysteropexy may capture more cases of subsequent cancer development.