Reasons for improper simple hysterectomy in patients with invasive cervical cancer in the northern region of Thailand.
OBJECTIVE
To determine the reasons for improper simple hysterectomy in the presence of invasive cervical cancer.


METHODS
The medical records of 70 patients who had undergone simple hysterectomy in the presence of invasive cervical cancer and were referred to Chiang Mai University Hospital between January 1991 and December 1998 were reviewed.


RESULTS
Approximately half of the patients presented with abnormal vaginal bleeding. Failure to perform a Papanicolaou smear before the operation accounted for 35.4%. Normal pelvic examination in which no gross invasive tumor was observed accounted for 59%. The most common indications for inappropriate operation was cervical dysplasia. The reasons for inappropriate simple hysterectomy included lack of preoperative cervical cytology (22.8%), incomplete evaluation of cervical dysplasia or microinvasion on biopsy (21.4%), false-negative cervical cytology (18.6%), failure to perform an endocervical curettage following conization (8.6%), emergency hysterectomy (8.6%), failure to perform indicated conization (5.6%), errors in colposcopic examination (4.3%), incomplete evaluation of an abnormal cervical cytology (1.4%), failure to perform endocervical currettage following loop conization (1.4%), failure to review slide (1.4%), failure to check the pathology report (1.4%), failure to biopsy a gross cervical lesion, and skipped lesion in upper part of the endocervix (1.4%). One case of invasive disease was missed for unknown reason.


CONCLUSIONS
Most cases of inappropriate hysterectomy resulted from deviation from guideline for cervical cancer detection. Preoperative Papanicolaou smear and strict adherence to the well-established diagnostic protocol for patients with an abnormal smear are advised to prevent such occurrence.
Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Thailand.
J
J
Srisomboon
A
A
Pantusart
C
C
Phongnarisorn
P
P
Suprasert
D000328:Adult; D000368:Aged; D001706:Biopsy; D003127:Colposcopy; D019092:Conization; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D065006:Papanicolaou Test; D013785:Thailand; D017211:Treatment Failure; D002578:Uterine Cervical Dysplasia / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D014626:Vaginal Smears