Hysteroscopic surgery does not adversely affect the long-term prognosis of women with endometrial adenocarcinoma.
OBJECTIVE
To determine the effect of hysteroscopic surgery on the long-term clinical outcome of women diagnosed with endometrial cancer.


METHODS
Prospective cohort study (Canadian Task Force classification II-3).


METHODS
University-affiliated teaching hospital.


METHODS
From January 1990 through December 2005, the principal author (GAV) performed primary hysteroscopic surgery in 3401 women with abnormal uterine bleeding. Among these women, there were 16 occult and 3 known endometrial cancers.


METHODS
All women underwent hysteroscopic evaluation and partial (n = 8) or complete (n = 11) rollerball electrocoagulation and/or endomyometrial resection. After diagnosis of endometrial malignancy, women were counseled regarding their disease and management, in accordance with established clinical practice guidelines. Follow-up ranged from 1 to 14 years and was conducted by office visits and telephone interviews.


RESULTS
Among the 3401 women, there were 19 women with endometrial adenocarcinoma, 3 of whom were known to harbor cancer before hysteroscopic surgery. One woman refused hysterectomy and remains alive and well 5 years after total hysteroscopic endomyometrial resection. Two women wished to maintain fertility; 1 consented to hysterectomy after incomplete resection of her lesion. The other was treated with progestins. Her cancer reverted to complex hyperplasia, and she requested hysterectomy 4 years later. No residual cancer was found. After 5 years of follow-up, 1 patient died from carcinoma of the gallbladder (2 years), and 2 died at 4 years; 1 at the age of 87 years of natural causes and the other at the age of 86 years from acute renal failure unrelated to her cancer. Fourteen women remain alive and well at 5 to 14 years of follow-up. Two additional women remain alive and well at 1 and 4 years of follow-up.


CONCLUSIONS
Resectoscopic surgery did not adversely affect the 5-year survival and the long-term prognosis in 14 women with endometrial cancer.
Vilos
George A
GA
Department of Obstetrics and Gynecology, The University of Western Ontario, London, Ontario, Canada. george.vilos@sjhc.london.on.ca
Edris
Fawaz
F
Al-Mubarak
Awatif
A
Ettler
Helen C
HC
Hollett-Caines
Jackie
J
Abu-Rafea
Basim
B
D000230:Adenocarcinoma / Q000175:diagnosis / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D008875:Middle Aged; D011379:Prognosis; D014592:Uterine Hemorrhage / Q000601:surgery*