Hysterectomy for cervical intraepithelial neoplasia: A retrospective observational multi‐institutional study

Abstract

Objective To analyze the clinical management, the outcomes, and the trend in hysterectomy rates (HR) in patients who underwent this procedure for cervical intraepithelial neoplasia (CIN). Methods Multicentric retrospective observational study conducted on 242 patients who underwent hysterectomy for CIN between 2010 and 2020 in nine Italian institutions. Hysterectomy for invasive or micro‐invasive neoplasia, sub‐total hysterectomy, or trachelectomy were excluded. Results A significant increase in the trend of HR for CIN was recorded (P = 0.002, r = 0.81; C.I. 95%: 0.415–0.949); HR increased from 0.46% in the year 2010 to 3.32% in 2020. The mortality rate was 0.4%, and 5% had operative complications. On definitive histopathology examination, a CIN of any grade was recorded in 71.5% of cases, and an occult invasive cancer in 1.24%. No pathology or CIN1 was found in 26.8% of cases, suggesting over treatment. During follow‐up, a vaginal lesion was recorded in 5% of cases. Conclusion A significant increase in the number of hysterectomies performed for CIN in the last 10 years was recorded. Hysterectomy for CIN can lead to complications, risk of the onset of vaginal lesions, and risk of overtreatment, and remains, in the first instance, an unacceptable treatment, to be proposed only after adequate counseling.

High‐grade vaginal intraepithelial neoplasia after hysterectomy for high‐grade cervical intraepithelial neoplasia: Is hysterectomy a “definitive” treatment compared to conization?

“…Andrea et al reported the development of high-grade VaIN and vaginal cancer in 7 out of 242 cases (2.89%). 7 In our study of 155 patients, this value was 2.6%. Other studies on VaIN recurrence have only focused on the early postoperative period; however, we think that our value is acceptable compared to previous reports.…”

“…3,4 Therefore, some reports suggest that hysterectomy is recommended for especially elderly CIN3 patients. 5,6 Although hysterectomy is more invasive than conization, 7 clinicians often explain to patients that it is a "definitive" treatment strategy. In other words, clinicians think that the hysterectomy will free the patient from frequent hospital visits without worrying about the possibility of development of cervical cancer.…”

“…Therefore, when the presence of VaIN 2/3 is discovered early in the postoperative period after hysterectomy, which is considered to be a more invasive and curative choice compared to conization, not only the patient but also clinicians sometimes feel disappointed. Although there are several reports referring to the cumulative incidence of VaIN 2/3 after hysterectomy for CIN3, 7,[13][14][15] there are few reports that investigated the early recurrence after hysterectomy for CIN3.…”

“…Recently, most hysterectomies for CIN3 have been performed laparoscopically. 7 Although it has been reported that the prognosis of cervical cancer treated by laparoscopic surgery is significantly poorer than that of laparotomy, 16 there are few reports on CIN3 in terms of laparoscopy or laparotomy. Therefore, in this study, we also examined whether different hysterectomy techniques affect the frequency of early recurrence of VaIN 2/3.…”

“…In addition, we investigated the effects of different methods on hysterectomy. Recently, most hysterectomies for CIN3 have been performed laparoscopically 7 . Although it has been reported that the prognosis of cervical cancer treated by laparoscopic surgery is significantly poorer than that of laparotomy, 16 there are few reports on CIN3 in terms of laparoscopy or laparotomy.…”