title: Gynecologic abnormalities in surgically treated women with stage II or III rectal cancer.
abstract: BACKGROUND
  The objective of this article is to review the incidence and management of gynecologic abnormalities in women undergoing surgery for rectal cancer.
  
  
  METHODS
  We performed a retrospective chart review utilizing the Johns Hopkins Tumor Registry and Pathology database. Eighty-six female patients who underwent abdominal surgery between 1985 and 1996 for Stage II or Stage III rectal cancer were identified. Data gathered included: patient demographics, history, intraoperative findings and complications, cancer stage and histology, adjuvant treatments, and followup. Specific attention was focused on the diagnosis, management, and followup of concurrent gynecologic problems.
  
  
  RESULTS
  At the time of surgery, nineteen women (22%) had previously undergone hysterectomy and bilateral salpingo-oophorectomy. Of the remaining 67 patients, 25 (37%) were found to have gynecologic abnormalities at the time of surgery, 15 (22%) underwent adnexectomy or hysterectomy or both. Forty-two women (63%) had normal internal genitalia. Of the 61 peri- and postmenopausal women, nine underwent bilateral oophorectomy for therapeutic reasons. No prophylactic oophorectomies were performed in any of the patients.
  
  
  CONCLUSIONS
  Incidental pathologic findings necessitating gynecological procedures are common in patients undergoing surgery for rectal cancer. These findings are frequently suboptimally assessed and managed in the pre-, intra-, and postoperative periods. Colorectal surgeons operating on women with Stage II and III rectal cancer should be cognizant of the high likelihood of identifying incidental gynecologic pathology and be prepared for definitive management of the pathology. The utilization of prophylactic oophorectomy in postmenopausal women undergoing surgery for rectal cancer is currently not optimal; preoperative discussion should address this option.
authors.affiliation: The Kelly Gynecologic Oncology Service, Departments of Gynecology and Obstetrics, The Johns Hopkins Hospital and Medical Institutions, Baltimore, MD 21287, USA.
authors.forename: Sven O
authors.initials: SO
authors.lastname: Becker
authors.forename: Raffael
authors.initials: R
authors.lastname: Tomacruz
authors.forename: Howard S
authors.initials: HS
authors.lastname: Kaufman
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
authors.forename: Fredrick J
authors.initials: FJ
authors.lastname: Montz
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D005831:Genital Diseases, Female / Q000453:epidemiology / Q000601:surgery*; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010052:Ovariectomy; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors