Gynecology & Obstetrics
Open Access
ISSN: 2161-0932
ISSN: 2161-0932
Ayman Oraif, George Vilos, Hanin Abduljabar, Angelos G Vilos, Helen Ettler and Basim Abu-Rafea
Accepted Abstracts: Gynecol Obstet (Sunnyvale)
Objectives: To determine long-term clinical outcomes following resectoscopic endometrial ablation in women with abnormal uterine bleeding and atypical endometrial hyperplasia and/or endometrial cancer. Study methods: From January 1990 through December 2012, the senior author (GAV) performed primary resectoscopic endometrial ablations in 4729 women, including 30 diagnosed with atypical endometrial hyperplasia and 26 diagnosed with endometrial cancer. In the atypical endometrial hyperplasia group, the endometrium was resected in 20, partially resected in 4 because of suspicious cancer, electrocoagulated in 3 and combination in 3 women. In the endometrial cancer group, the endometrium was completely resected or electrocoagulated in 14, partially resected in 9 because of suspicious cancer, and 3 women with highly suspicious cancer had resectoscopic directed biopsy only. 9mm (26F) resectoscope, 1.5% glycine and 120w of power were used.After diagnosingatypical endometrial hyperplasia or cancer, women were offered standard treatment as per clinical guidelines. Follow up was conducted annually in both groups. Results: In the atypical endometrial hyperplasia group,the median (range) age, parity and body mass index were 51.5 years (24-78 years), 1(0-4) and 30.1 kg/m2 (21-58.2 kg/m2), respectively.Of the atypical hyperplasia, 26 were complex and 4 simple. The diagnosis was known in 13 women pre-operatively and in 17 it was made post-resectoscopic ablation. After discussion, 10 women underwent immediate hysterectomy+bilateralsalpingooophorectomy. At a median follow-up of 7 years (range 1-21 years), two women (10%) developed endometrial cancer at 11 years declared with vaginal bleeding, one of whom developed rectal cancer at 20 years.Two additional women died of lung cancer after 4 years and one of colon cancer after 5 years.The remaining 16 remain amenorrheic followed annually by transvaginalsonography.In the endometrial cancer group, one woman refused hysterectomy. She remains alive and well after 12 years.Two women wished to retainfertility. One,diagnosed by office biopsy, had hysterectomy after partial resection with presence of residual cancer. The other was treated with high dose progestins for 6 months. Repeat biopsy indicated regression to complex hyperplasia without atypia. She failed to conceive and had a hysterectomy at 4 years. Two women died at 4 years, one from renal failure at 86 and the other naturally at 87. Two additionalwomen died from cancer of the gallbladder after 2 years and pancreatic after 13 years.At 5-19 and 1-4 years after resectoscopic surgery and hysterectomy, 15and 4 patients remain alive and well, respectively. Conclusions: 1.Resectoscopic endometrial ablation in women with atypical endometrial hyperplasia is feasible, safe and effective, does not alter long-term clinical outcomes, and may be an alternative to hysterectomy by experienced surgeons.2. Resectoscopic endometrial ablation in women with abnormal uterine bleeding and concomitant endometrial cancer does not adversely affect their long-term clinical outcomes and 5-year survival.