[Prophylactic hysterectomy in Lynch syndrome: Feasibility and outcomes].

Authors:
L Rossi
L Rossi
University of Turin
Italy
C Ngo
C Ngo
Murdoch Childrens Research Institute
Australia

Gynecol Obstet Fertil Senol 2019 Jun 16;47(6):497-503. Epub 2019 Apr 16.

Chirurgie cancérologique gynécologique et du sein, hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France; Inserm UMR-S 747, université Paris-Descartes, 75015 Paris, France; Faculté de Médecine, Sorbonne Paris-Cité, université Paris-Descartes, 75006 Paris, France. Electronic address:

Objectives: Lynch syndrome (LS) is a hereditary predisposition to cancers, first of all, colo-rectal and endometrial cancers in women. Although recommended, gynecologic screening has never proven its benefit. Prophylactic surgery can be considered once the parental project is completed. There are few data regarding the assessment of prophylactic surgery. The objectives of our study were to evaluate the feasibility and morbidity of prophylactic hysterectomy in patients with Lynch syndrome.

Methods: This is a descriptive retrospective study of consecutive patients with LS undergoing prophylactic hysterectomy at the Georges-Pompidou European Hospital from 2002 to 2016. We collected demographic characteristics, results of preoperative assessment, intra- and postoperative data, final pathologic result as well as postoperative follow-up data.

Results: Forty patients were included in the study, and seventeen women had a history of colon cancer surgery. All hysterectomies were performed by laparoscopy, with two cases of laparoconversion. Two intraoperative complications occurred: serosal small bowel injuries and superficial bladder injury. Two early postoperative complications occurred (a peritonitis on small bowel perforation and a peritonitis on left ureteral injury) and two late complications (vesico-vaginal fistula and adhesive small bowel obstruction). All operative specimens were benign. With a median follow-up of 28 months [5-52], no patient had peritoneal cancer.

Conclusions: Our study shows that prophylactic hysterectomy in Lynch syndrome should be done with caution. Per and postoperative complication rates appear to be higher than in general population, probably related to a more frequent history of colorectal cancer. However, total hysterectomy with bilateral salpingo-oophorectomy appears to be an effective strategy for preventing gynecological cancers in women with the Lynch syndrome.

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http://dx.doi.org/10.1016/j.gofs.2019.04.010DOI Listing
June 2019
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