Hysterectomy for cervical intraepithelial neoplasia: A retrospective observational multi‐institutional study
Andrea Ciavattini, Jacopo Di Giuseppe, Chiara Marconi, Luca Giannella, Giovanni Delli Carpini, Michela Paolucci, Mariasole Fichera, Rosa De Vincenzo, Giovanni Scambia, Maria Teresa Evangelista, Giorgio Bogani, Francesca Bertolina, Francesco Raspagliesi, Bárbara Gardella, Arsenio Spinillo, Mattia Dominoni, Ermelinda Monti, Carlo Antonio Liverani, Paolo Vercellini, Maria De Iorio, Domenico Vitobello, Rosalba Portuesi, Gianluigi Bresciani, Massimo Origoni, Francesco Cantatore, Antonio Maurizio Pellegri, Lorenzo Moriconi, Matteo Serri, Andrea Chiari, Francesco Sopracordevole, Maggiorino Barbero, Fabio Parazzini, the Italian Society of Colposcopy and Cervico‐Vaginal Pathology (SICPCV)
Abstract
OBJECTIVE: To analyze the clinical management, the outcomes, and the trend in hysterectomy rates (HR) in patients who underwent this procedure for cervical intraepithelial neoplasia (CIN). METHODS: Multicentric retrospective observational study conducted on 242 patients who underwent hysterectomy for CIN between 2010 and 2020 in nine Italian institutions. Hysterectomy for invasive or micro-invasive neoplasia, sub-total hysterectomy, or trachelectomy were excluded. RESULTS: A significant increase in the trend of HR for CIN was recorded (P = 0.002, r = 0.81; C.I. 95%: 0.415-0.949); HR increased from 0.46% in the year 2010 to 3.32% in 2020. The mortality rate was 0.4%, and 5% had operative complications. On definitive histopathology examination, a CIN of any grade was recorded in 71.5% of cases, and an occult invasive cancer in 1.24%. No pathology or CIN1 was found in 26.8% of cases, suggesting over treatment. During follow-up, a vaginal lesion was recorded in 5% of cases. CONCLUSION: A significant increase in the number of hysterectomies performed for CIN in the last 10 years was recorded. Hysterectomy for CIN can lead to complications, risk of the onset of vaginal lesions, and risk of overtreatment, and remains, in the first instance, an unacceptable treatment, to be proposed only after adequate counseling.