Hysterectomy for primary gynaecological malignancies in a non-cancer centre: prevalence, indications and surgical outcomes at a tertiary hospital in Port-Harcourt, Nigeria: a six-year review

Authors

  • Peter A. Awoyesuku Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, 6-8 Harley Street, Old G.R.A, Port-Harcourt, Rivers State, Nigeria
  • Ngozi J. Kwosah Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, 6-8 Harley Street, Old G.R.A, Port-Harcourt, Rivers State, Nigeria
  • Dickson H. John Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, 6-8 Harley Street, Old G.R.A, Port-Harcourt, Rivers State, Nigeria
  • Simeon C. Amadi Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, 6-8 Harley Street, Old G.R.A, Port-Harcourt, Rivers State, Nigeria

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20214310

Keywords:

Gynaecological malignancies, Hysterectomy, Endometrial cancer, Cervical cancer, Ovarian cancer, Choriocarcinoma

Abstract

Background: Gynaecological malignancies continue to be an important public health problem globally and are among the leading causes of morbidity and cancer-related deaths worldwide. In developing countries there is poor awareness and late presentation, and specialized cancer treatment centers are few, necessitating the gynaecologists at the tertiary hospitals to render surgical care for some cancer patients. The objective of the study was to determine the prevalence, indications, and surgical outcome of hysterectomy for primary gynaecological malignancies and assess the associated factors.

Methods: This was a retrospective review of hysterectomies performed between March 2015 and February 2021. Data were obtained from operating theater and gynaecological ward records. Information on age, parity, indication, length of surgery, blood loss and any blood transfusion, post-operative complication, and mortality, were extracted. Data were analyzed using Statistical package for social sciences (SPSS) version 20.

Results: Of 1240 major gynaecological surgeries, 26 were hysterectomies for malignant conditions giving a prevalence of 2.1%. Commonest indication was Endometrial cancer 16 (61.5%), followed by cervical cancer 3 (11.5%) and ovarian malignancy 3 (11.5%). There was a significant relationship between age (p=0.027) with the indications for hysterectomy. Commonest complication was anaemia 6 (23.1%) and wound sepsis 5 (19.2%). Anaemia was significantly associated with duration of surgery (p=0.004) and estimated blood loss (p=0.005).

Conclusions: The prevalence of 2.1% for a non-cancer center is a fair contribution to efforts at caring for cancer patients. All surgeries were simple TAH±BSO and more than half were done for endometrial cancer. Further training of cancer surgeons and establishment of a Cancer Centre in the State is needed.

References

Iyoke CA, Ugwu GO. Burden of gynaecological cancers in developing countries. World J Obstet Gynecol. 2013;2(1):1-7.

Anon. A policy framework for commissioning cancer services. A joint Working Group response by the Royal College of Obstetricians and Gynaecologists and the British Gynaecological Cancer Society. London: RCOG Press. 1997.

The Economist Intelligence Unit. Breakaway: The global burden of cancer-challenges and opportunities. The Economist. 2009.

Ferlay J, Bray F, Norman D, Mathers C, Parkin DM. GLOBOCAN 2008, Cancer incidence and mortality worldwide. International Agency for Research on Cancer. 2008.

Cohen CJ. The Role of Surgery in the Treatment of Gynecologic Cancers – A Shifting Paradigm. Business Briefing: US Oncology Review. 2004;2(1):2-4.

Howard WJ. Abdominal hysterectomy. In: John AR, Howard WR. editors. Te Linde’s Operative Gynecology. 10th ed. Philadelphia; Lippincott Williams and Wilkins. 2008;6:727-33.

International Agency for Research on Cancer. GLOBOCAN 2008 Fast stats. Available at: http://www.globocan.iarc.fr/ Accessed on 30 August 30 2021.

Kitchener HC. Progress in the management of solid tumours: Gynaecological cancer. Postgrad Med J. 1999;75:332-8.

Sankaranarayanan R, Ferlay J. Worldwide burden of gynaecological cancer: the size of the problem. Best Pract Res Clin Obstet Gynaecol. 2006;20:207-25.

Fader AN, Arriba LN, Frasure HE, von Gruenigen VE. Endometrial cancer and obesity: epidemiology, biomarkers, prevention and survivorship. Gynecol Oncol. 2009;114:121-7.

Savage J, Adams E, Veras E, Murphy KM, Ronnett BM. Choriocarcinoma in women. The American Journal of Surgical Pathology. 2017;41(12):1593-606.

FLam F. Emergency surgery in gestational trophoblastic tumours. Eur. J. Obstet. Gynecol. Reprod. Biol 1994;55:183.

Tse K.Y, Chan KK, Tam KF, Ngan HY. 20-year experience of managing profuse bleeding in gestational trophoblastic disease. J Reprod Med. 2007;52:397.

Tomoda Y, Arii Y, Kaseki S, Asai Y, Gotoh S, Suzuki T et al. Surgical indications in pulmonary metastasis of choriocarcinoma. Cancer. 1980;46:2723.

Ishizuka T, Tomoda Y, Kaseki S, Goyo S, Hara T, Kobayashi T et al. Intracranial metastasis of choriocarcinoma: A clinicopathologic study. Cancer. 1983;52:1896.

Lehman E, Gershenson DM, Burke TW, Leveback C, Silva EG, Morris M. Salvage surgery for chemo refractory gestational trophoblastic disease. J. Clin. Oncol. 1994;12:2737.

Gabra H, Blagden S. Epithelial Ovarian Cancer. In: Dewhurst’s Textbook of Obstetrics and Gynaecology for Postgraduates. Edmonds DK. (Ed) 8th edition. London: John Wiley and Sons Ltd. 760-775.

Yakasai IA, Ugwa EA, Otubu J. Gynecological malignancies in Aminu Kano Teaching Hospital Kano: A 3 year review. Nigerian J Clin Pract. 2013;16(1):63-6.

Rabiu A, Habib R. Elective abdominal hysterectomy: Appraisal of indications and complications at Aminu Kano Teaching Hospital – An 8-year review. Trop J Obstet Gynaecol. 2017;34:224-8.

Adenaya OR, Ojo OO, Ade-Onojobi AO. Pattern of Gynaecological Total Abdominal Hysterectomy (TAH) in Abeokuta, Southwest Nigeria; a Five-Year Review. Journal of Medical Science and Clinical Research. 2020;8(5):297-304.

Abah MG, Olatunbosun OA. An audit of gynaecological hysterectomies in the university of Uyo teaching hospital: Case for non-descent. International Journal of Clinical Obstetrics and Gynaecology. 2019;3(5):161-5.

Hacker NF, Friedlander M. Uterine cancer. In: Berek JS, Hacker NF, editors. Berek and Hacker’s Gynecologic Oncology. 6th ed. China: Library of Congress Cataloguing-in-publication Data. 2015;390-442.

Berrino F, Sant M, Verdecchia A. editors. Survival of cancer patients in Europe: the EUROCARE study. Lyon: International Agency for Research on Cancer. 1995.

Smith-Bindman R, Kerlikowske K, Feldstein VA. Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. JAMA. 1998;280:1510-7.

Downloads

Published

2021-10-27

Issue

Section

Original Research Articles