Is There Still a Place for Hysterectomy for Treatment of Recurrent Squamous Intraepithelial Lesions?

Abstract

Objective:

This research was conducted to evaluate if colposcopy and cervical biopsy could predict the extent of premalignant uterine cervix lesions and if there is still a place for hysterectomy for treating recurrent lesions in patients who underwent previous cervical surgical procedures.

Materials and Methods:

This was a retrospective analysis of patients after large loop excision of the transformation zone (LLETZ) in whom hysterectomy was performed in the authors' institution between 2010 and 2018 due to recurrent low-grade squamous intraepithelial lesions (LSIL) or high-grade squamous intraepithelial lesions (HSIL). A comparison between preoperative and postoperative histopathologic diagnoses (HPD) was made. The modes of hysterectomy and complication rates were analyzed.

Results:

Of 50 patients, preoperative and postoperative HPD matched in 46%. HPD was upgraded to HSIL in 2% and downgraded to LSIL in 16%. In 20% (all with HSIL), no lesions were found postoperatively. One patient had a microinvasive carcinoma. In 12%, the procedure indication was a pathologic Papanicolaou smear excluding HSIL; LSIL was found in only 1 of these patients. Laparoscopy was performed in 49%, vaginal in 33%, abdominal in 8%, and laparoscopically assisted vaginal approach in 12%. Postoperative complications occurred in 12%, and treatment was successful in 98%.

Conclusions:

Hysterectomy should be performed with care in recurrent SIL—only after exclusion of invasive cancer. With more than 50% of mismatches between pre- and postoperative diagnoses in the current study, it is vital to improve preoperative diagnostics. If hysterectomy is indicated, patient safety and postoperative complications should be taken into account and a minimally invasive approach should be taken if possible.