The extra 1.5 cm makes the differences: reduced incidence of vaginal intraepithelial neoplasia after modified hysterectomy for CIN3/adenocarcinoma in situ (AIS) patients

Abstract

\n Objectives\n\nTo assess whether modified hysterectomy can improve locoregional control compared to the standard extrafascial hysterectomy for cervical high grade intraepithelial neoplasia 3 (CIN3)/adenocarcinoma in situ (AIS) patients.\nMethods\n\nA total of 135 CIN3/AIS patients from May 2014 to March 2018 were enrolled and randomized to different hysterectomy group and finally 128 patients were eligible for analysis, in which 60 patients received standard extrafascial hysterectomy and 68 patients received modified hysterectomy by removing extra 1.5cm of vagina. Intra-operative variables including operative time, estimated amount of blood loss, urinary catheter time, hospital stay time and postoperative complications, most importantly the postoperative recurrence and disease free survival (DFS) were compared and analyzed.\nResults\n\nAge, BMI and histology grade were comparable between these two groups. No significant differences were found at median surgical times, blood loss and postoperative hospital stay neither laparoscopicly nor abdominally, and neither was found about the incidences of fistulas, or other surgical complications. No incidences of prolonged urinary retention were found in both groups. With a median follow-up of 47.3 months (range 11–64 months), the modified hysterectomy group and had a significantly improved in DFS rate compared to the standard extrafascial hysterectomy group (P\u2009=\u20090.026). No disease related death occurred in the follow-up time.\nConclusion\n\nWith similar intra-operative variables operative time, modified hysterectomy appeared to provide the most reliable specimens and significantly reduced the postoperative vaginal recurrence rate for CIN3/AIS patients who choose remove their uterus when compared with standard extrafascial hysterectomy.