Cervicectomy following supravaginal hysterectomy

Abstract

1.1. A total of 35 patients with previous supravaginal hysterectomy subjected to cervicectomy during the 10 year period, 1948–1957, were reviewed.2.2. In 23 (66 per cent) patients, the supravaginal hysterectomy was performedaas a routine procedure. Leiomyoma uteri was the most common indication for hysterectomy. The responsibility of the gynecologist in following up the patients with retained uterine cervices and the importance of performing total hysterectomy are stressed.3.3. The time interval between the supravaginal hysterectomy and the discovery of malignancy of the cervical stump varied from 6 months to 20 years, averaging 8 years. Hence, there is no “age limit” with regard to cervicectomy. Patients with cervical stumps may necessitate cervicectomy at any age.4.4. Vaginal spotting and cervical prolapse were the two most common symptoms and convinced both the patient and the gynecologist that cervicectomy was indicated.5.5. Chronic cervicitis was the most frequent pathological finding. There were 13 such cases. Malignancy was suspected in 7 cases, and among these one proved to be an adenocarcinoma, Grade III. Four patients with biopsies positive for malignancy were subjected to cervicectomy.6.6. Vaginal cervicectomy was done in 23 (65 per cent) cases; the abdominal route was employed in 12 cases.7.7. There was no satisfactory correlation between the Papanicolaou smears and cervical biopsies. This study shows that in the presence of signs or symptoms pertaining to the retained cervix, a cervical biopsy is imperative to establish the diagnosis.8.8. Chronic cervicitis with or without prolapse of the stump was found in 63 per cent of patients. There were 5 cases of cervical malignancy. Two patients had epidermoid carcinoma in situ; one patient had epidermoid carcinoma, Stage I. A fourth patient had an adenocarcinoma, Grade III. The fifth patient had a leiomyosarcoma of the cervix, but it was not a recurrence. The pathological diagnosis after hysterectomy was leiomyoma uteri.9.9. The most common postcervicectomy complications were those of the urinary bladder.10.10. The incidence of cervical malignancy in this series of 35 women with retained uterine cervices was 14.3 per cent. In this series, the incidence of carcinoma of the cervical stump was 11.4 per cent. Among the 322 patients treated for cervical carcinoma during the 10 year period, 1948–1957, there were 4 cases which developed in cervical stumps. This gives an incidence of 1.2 per cent for cervical stump carcinoma in this series.