Hysterectomy for primary gynaecological malignancies in a non-cancer centre: prevalence, indications and surgical outcomes at a tertiary hospital in Port-Harcourt, Nigeria: a six-year review

Abstract

Background: Gynaecological malignancies continue to be an important public health problem globally and are among the leading causes of morbidity and cancer-related deaths worldwide. In developing countries there is poor awareness and late presentation, and specialized cancer treatment centers are few, necessitating the gynaecologists at the tertiary hospitals to render surgical care for some cancer patients. The objective of the study was to determine the prevalence, indications, and surgical outcome of hysterectomy for primary gynaecological malignancies and assess the associated factors.Methods: This was a retrospective review of hysterectomies performed between March 2015 and February 2021. Data were obtained from operating theater and gynaecological ward records. Information on age, parity, indication, length of surgery, blood loss and any blood transfusion, post-operative complication, and mortality, were extracted. Data were analyzed using Statistical package for social sciences (SPSS) version 20.Results: Of 1240 major gynaecological surgeries, 26 were hysterectomies for malignant conditions giving a prevalence of 2.1%. Commonest indication was Endometrial cancer 16 (61.5%), followed by cervical cancer 3 (11.5%) and ovarian malignancy 3 (11.5%). There was a significant relationship between age (p=0.027) with the indications for hysterectomy. Commonest complication was anaemia 6 (23.1%) and wound sepsis 5 (19.2%). Anaemia was significantly associated with duration of surgery (p=0.004) and estimated blood loss (p=0.005).Conclusions: The prevalence of 2.1% for a non-cancer center is a fair contribution to efforts at caring for cancer patients. All surgeries were simple TAH±BSO and more than half were done for endometrial cancer. Further training of cancer surgeons and establishment of a Cancer Centre in the State is needed.

Profile of women with Gynaecological cancers at a Tertiary Hospital in Southern Nigeria

“…Gynaecological cancers are malignancies of the genital tract which involves the cervix, ovary, uterus, vulva, vagina, and gestational trophoblastic neoplasia (GTN) [1]. These malignancies have different epidemiology, pathology, and management interventions [2]. Though cancers of the uterus, cervix, vagina, vulva, ovary, choriocarcinoma and fallopian tubes are managed by the gynaecologists, breast cancer is mostly managed by general surgeons in many developing countries, Nigeria inclusive [3].…”

“…The global cancer data reveal that the burden has risen to 18 million cases and 9.6 million deaths annually, with over 50% of the new cancer incidences recorded in Asia [4]. Gynaecological cancers remain a crucial public health menace worldwide, as it is among the leading causes of morbidity in women and cancer-associated mortalities globally [2]. Aside breast cancer, gynaecological cancers are the second most common cancers, accounting for over 17% of all types of cancers in women [5].…”

“…Factors such as age and parity have been identified as some of the major risk factors for gynaecological cancers. Endometrial and ovarian cancers are more common in older women, while choriocarcinoma occur in the younger age group [2,8]. Although multiparity has been reported as a protective factor against endometrial and ovarian cancers, it is a major risk factor for cervical cancer [2].…”

“…Endometrial and ovarian cancers are more common in older women, while choriocarcinoma occur in the younger age group [2,8]. Although multiparity has been reported as a protective factor against endometrial and ovarian cancers, it is a major risk factor for cervical cancer [2]. Hence, the study sought to determine the socio-demographic, reproductive, and clinical profile of gynaecological cancer patients at the University of Port Harcourt Teaching Hospital in River state, Nigeria.…”