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Re: Supracervical HysterectomyFrom: Mats Bergstrom (matsb@sos.sll.se)Tue Oct 31 08:36:43 1995
Gordon M. Goldman wrote:
> Why not just do a supracervical and let it go at that?? Good point. Why not? Combined with electrocautery of the cervical canal this is a very safe procedure: Kilkku P. Gronroos M. Peroperative electrocoagulation of endocervical mucosa and later carcinoma of the cervical stump. x Acta Obstetricia et Gynecologica Scandinavica. 61(3):265-7, 1982. Abstract: 'The incidence of carcinoma of the cervical stump is, according to literature, 0.3--1.9%. During the years 1952--78, 2712 subtotal hysterectomies for benign conditions were performed in the Department of Obstetrics and Gynecology in Turku. During the operation the endocervical mucosa was electrocoagulated before closing the stump. Of these patients, 3 have since developed carcinoma of the cervical stump; thus the incidence in our material is 0.11%. It has been supposed that subtotal hysterectomy might have certain benefits in some cases. If so, and in view of the cancer risk being so low in our material, we feel that subtotal hysterectomy is still an applicable method.' Note the number of patients. A study not easily repeated!
> that line of reasoning, we should not be removing ovaries from In November 1993 a Swedish governmental institution (SPRI, 'Institute of Health Care Development') invited some 'distinguished' gynecologists (and some people from other disciplines) to a consensus conference titled 'Remove the uterus? Causes, methods and alternatives' in benign conditions of the uterus. An excerpt from the resulting consensus: 'Therefore, to remove the ovaries is only recommended in women with a hereditary disposition for ovarian cancer.' Just like that, with no exceptions for any age group! Of course, this has been debated afterwards and far from all colleagues go by this recommendation. Laparotomy for benign uterine conditions in advanced age is not very common (residual myoma, preoperatively hard to distinguish from an adnexal mass, comes to mind) so one doesn't have to confront this issue very often. Personally, I have a slight problem with leaving the ovaries in 80 year old's (when even the androgen production should have ceased...) but under the age of (arbitrary) 60 I have not.
-- Mats Bergstrom, MD Ob Gyn South Hospital Stockholm
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