Reasons for inappropriate simple hysterectomy in the presence of invasive cancer of the cervix

We evaluated 148 women who had had simple hysterectomy in the presence of invasive cervical cancer between the years 1973–1987. Two had microinvasive squamous carcinoma for which hysterectomy was not a planned procedure. The remaining 146 women all had either adenocarcinoma or squamous carcinoma exhibiting greater than 3 mm of stromal invasion or lymph-vascular space involvement. Medical records were reviewed retrospectively to determine the reasons for hysterectomy. Causes of inappropriate hysterectomy were as follows: inadequate evaluation of an abnormal Papanicolaou smear or cervical biopsy (21%), failure to perform an indicated conization (12%), deliberate hysterectomy for grossly invasive cancer of the cervix (11%), lack of preoperative Papanicolaou smear (7%), conization margins positive or not evaluated (7%), misreading of pathology results (5%), emergent operation because of bleeding (3%), failure to check cytology preoperatively (1.5%), and failure to biopsy a gross cervical lesion (1.5%). The remaining 31% of cases had normal or inflammatory Papanicolaou smears and negative cervical examinations. Although 93% of this latter group complained of abnormal bleeding, 78% did not have endocervical or endometrial sampling preoperatively. Despite the increasing emphasis on cervical cancer screening, the number of referrals following hysterectomy performed in the presence of cervical carcinoma is not decreasing. Most cases could be avoided by careful adherence to well-established guidelines for cervical cancer detection.