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Morbidity associated with total abdominal hysterectomy as treatment for endometrial cancer: outcomes from 2years data collection
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Dr Faiza Waliullah, Dr Alexandra Rice, Dr Kate Christen, Dr Oliver Milling Smith, Department of Obstetrics and Gynaecology, Forth Valley Royal Hospital, Larbert,UK
Objectives
Methods
Results
A retrospective audit of the morbidities
associated with total abdominal
hysterectomy in patients with
endometrial cancer diagnosed and
treated within Forth Valley Health
Board between January 2009 and
December 2010.
76 patients were diagnosed with
endometrial cancer, having been
identified by the Gynaecology
Oncology team and had a total
abdominal hysterectomy as part of their
management plan. Of these, 41
patients were included in the study as
they were both diagnosed and treated
in Forth Valley.
• The average patient was 66 years of age (range
35- 87) and had an average hospital stay of 5
days.
• The average haemoglobin prior to total
hysterectomy was 13.0g/dl and day 2 post op
11.1g/dl, which equated to an average drop of
2.3g/dl. Estimated blood loss ranged from minimal
to 3500ml, average loss being 464ml.
• 95% of patients received intra-operative
antibiotics.
• The 2 patients with no documentation of intraoperative antibiotics did not develop any post-op
infections.
• 10 patients developed post-op infections.
• All of them received antibiotics and a source was
identified in 40%. 98% had LMWH prescribed and
56% had documentation of TED stockings.
• There were no reported DVTs.
• Endometrial cancer is the fourth
most common cause of cancer in
women in the UK1,2.
• Total abdominal hysterectomy
(TAH) has been widely used as the
treatment of choice for endometrial
cancer.
• It is however invasive surgery with
an associated morbidity.
• Total laparoscopic hysterectomy
(TLH) is a minimally invasive
technique and studies have shown
it to be safe and effective. (ref
NICE)
A retrospective study was undertaken,
reviewing various outcomes to
measure morbidity. These included pre
and day 2 post operative haemoglobin,
any return to theatre, post op infection,
duration and strength of analgesia and
length of stay in hospital. Patient age
and past medical history were also
noted.
Conclusions
Of those patients who met the inclusion criteria (n=41),
1. 100% stayed in hospital for >2 days compared to 52% of the
patients who underwent a laparoscopic hysterectomy in a large
RCT.
2. Post operative complications reported in the study for open
hysterectomies were at 21%.
3. Post operative infection rates were 24%, most of which were
pyrexia of unknown origin and all were treated with antibiotics.
4. No patients developed thromboembolism and prophylaxis
with LMWH was given to 98% of the patients. However,
there were 2 patients who had a prolonged hospital stay.
6. One who developed post operative urinary infection, small bowel
obstruction which spontaneously resolved and wound infection
and the other patient with excessive bleeding requiring blood
transfusion.
7. A further study was undertaken comparing TLH to TAH, results of
which are shown in the graphs.
References
1. ISD Online, Cancer Incidence, Mortality and Survival data.
2008, Information and Statistics Division, NHS Scotland.
2.Office for National Statistics, Cancer Statistics registrations:
Registrations of cancer diagnosed in 2005, England. Series MB1
no.36. 2008, National Statistics: London.
3.Sokol AI, Green IC. Laparoscopic Hysterectomy. Clin Obstet
Gynecol. Sep;52(3):304-12. 2009