Subtotal hysterectomy reviewed: a stable or aperture for stump cervical malignancy. A referral hospital experience

Abstract

Introduction To review the malignant potential of the stump after subtotal abdominal hysterectomy. Material and methods: Thirty-three patients with stump malignancy were diagnosed and treated between January 2018 and January 2022. All patients primarily underwent subtotal hysterectomy (STH) outside our hospital due to different indications, most of which seemed non-convincing. Upon presentation, they were evaluated properly and offered the best management plan. Results The presenting symptoms were abnormal histopathology report in 8 patients (24.24%), abnormal bleeding in 7 patients (21.21%), and postcoital bleeding and abnormal Pap smear in 6 patients (18.18%). The primary site of malignancy was endometrial in 17 patients (51.51%), on top of fibroid in 6 patients (18.18%), and cervical in 5 patients (15.15%). Eighteen patients (54.54%) underwent proper surgery, 9 patients (27.277%) were referred for chemoradiation, and 6 patients (18.18%) were candidates for palliative therapy. Conclusions Stump cancer cases show a worse stage silhouette compared with cancer cases in intact uteruses. The high prevalence of cervical stump problems should be taken into account before a change in surgical approach from total to STH is deemed possible. Further prospective studies with prolonged follow-up periods are needed to evaluate the risks and benefits of retaining the cervix at hysterectomy. Subtotal hysterectomy is easier, does not require distinct skills that lead to experience and follow-up, and must be limited to the narrowest limits of practice, provided that the woman knows that there are no health benefits to keeping the cervix in place.

Cervical cancer screening in Jordan; a review of the past and an outlook to the future – facts and figures

“…Vaccinations against cervical cancer must be kept in mind, and they are an important target to address because 600 women (91.6%) had no idea about the vaccine or its purpose, and even though 35 women (5.3%) were aware of this vaccine, they were not happy to be vaccinated; and only 20 women (3.1%) had taken the vaccine before [22][23][24]. Early diagnosis of cancerous diseases gives a recovery opportunity for the patient, especially by employing therapeutic skills, especially the surgical skills that come to the fore in the surgical steps [25].…”

Total or Subtotal Hysterectomy for the Treatment of Endometriosis: A Review

“…Nevertheless, recent publications have contradicted these assertions and revealed that, compared with total abdominal hysterectomy, subtotal hysterectomy did not improve outcomes in terms of urinary or sexual function. Not surprisingly, women who underwent subtotal hysterectomy were more likely to experience postoperative vaginal bleeding from the cervical stump until one year after surgery compared with women who underwent total abdominal hysterectomy [25][26][27]. The potential development of carcinoma on the cervical stump is a further cause of concern.…”

“…The potential development of carcinoma on the cervical stump is a further cause of concern. The presence of cancer can be determined with relative accuracy only during the procedure [25].…”

“…Although subtotal hysterectomy is easier to perform and involves less extensive surgery, shorter operating times, and less perioperative bleeding [25], it does bear the risk of persistent pain and repeat surgery [22,[28][29][30]. Several studies advise against subtotal hysterectomy in women with endometriosis, pelvic pain, or dysmenorrhea [22,28,29].…”