Risk of unexpected malignancy in Chinese women undergoing vaginal hysterectomy for pelvic organ prolapse
IUGA Academy. Cheng M. Jun 30, 2018; 212911; 462 Topic: Pelvic Organ Prolapse
Dr. Mei Chi Cheng
Dr. Mei Chi Cheng

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Risk of unexpected malignancy in Chinese women undergoing vaginal hysterectomy for pelvic organ prolapse

Cheng, MC1; Ma, WS1

1: Queen Mary Hospital, Hong Kong

Introduction: Pelvic organ prolapse (POP) is a common gynaecological problem, which can have significant impact on women’s quality of life. Vaginal hysterectomy together with pelvic floor repair has been the most common procedure performed. There has been gaining popularity of uterine preservation surgery for POP, as it is associated with less blood loss, shorter operative time, quicker recovery and fewer urinary symptoms [1], while achieving similar success rates. Previous studies have shown that the incidence of unexpected malignancy in women undergoing vaginal hysterectomy for pelvic organ prolapse was 0-4.2% [2]. There was also some data showing lower prevalence of endometrial cancer in Asian populations [2].

Objective: The aim of this study is to evaluate the risk of unexpected malignancy in Chinese women undergoing vaginal hysterectomy for POP. We also try to identify the risk factors which may signify increase in risk of significant uterine pathology, thus in clinical practice, this group of patients will not be advised for uterine preserving surgery.

Methods: This is a retrospective study on patients who have undergone vaginal hysterectomy and pelvic floor repair for POP in a single institute from January 2013 to December 2018. Total 168 patients are identified.

Patients who are non-Chinese, having pre-malignant or malignant histology on pre-operative endometrial biopsy, or abnormal cytology on the last cervical smear will be excluded. Age at operation, body mass index, menopausal status and whether there is risk factor for endometrial pathology (such as on hormonal replacement therapy or Tamoxifen) are recorded. The severity of pelvic organ prolapse is assessed using Pelvic Organ Prolapse Quantification (POP-Q). Women who had abnormal vaginal bleeding should have been assessed pre-operatively, and their endometrial biopsy and ultrasound scan results are recorded. The pathology of hysterectomy specimen are recorded. The primary outcome is the risk of unexpected malignancy or pre-malignant condition in Chinese women undergoing vaginal hysterectomy for pelvic organ prolapse. The secondary outcome is to identify the risk factors for having significant uterine pathology on hysterectomy specimen.

Results: Total 154 cases were included. 95.5% of cases were post-menopausal. 51.9% of cases had prolapse with POP-Q stage III. 65 cases (42.2%) had abnormal uterine bleeding before hysterectomy. No uterine malignancy and 3 cases (1.9%) of atypical endometrial hyperplasia were found on hysterectomy specimen. All these 3 cases had post-menopausal bleeding. Among these 3 cases, one was on Tamoxifen for her breast cancer and pre-operative ultrasound pelvic showed endometrial thickness of 9mm. The other one had pre-operative endometrial aspirate showing disintegrating endometrium despite post-menopausal status.

Conclusions: It is important to counsel patients that there is low but not negligible risks of having pre-malignant or malignant uterine pathology when they are deciding uterine preservation surgery for POP. Postmenopausal women who had postmenopausal bleeding or women with risks of having endometrial pathology such as on Tamoxifen should be properly investigated before uterine preservation surgery.


  1. Int Urogynecol J.2012 May;23(5):625-31. doi: 10.1007/s00192-011-1635-5. Epub 2012 Feb 7.
  2. Aust N Z J Obstet Gynaecol.2013 Apr;53(2):190-6. doi: 10.1111/ajo.12033. Epub 2013 Jan 15.


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