Endometrial cancer after endometrial ablation: a systematic review

OBJECTIVE

To investigate whether a previously performed endometrial ablation is associated with the development and diagnosis of endometrial cancer.

METHODS

First, a systematic review was performed of the articles reporting the incidence of endometrial cancer in patients treated with endometrial ablation. Second, a systematic review was performed to identify all individual cases of endometrial cancer after ablation to evaluate presenting symptoms, diagnostic work-up, potential risk factors, and the type and stage of the endometrial cancer. A systematic search was performed, using Medline, EMBASE, and the Cochrane Library databases, from inception through February 24, 2022.

RESULTS

Based on 11 included studies, the incidence of endometrial cancer in a population of 29 102 patients with a prior endometrial ablation ranged from 0.0% to 1.6%.A total of 38 cases of endometrial cancer after ablation were identified. In 71% of cases (17 of 24 cases), vaginal bleeding was the first presenting symptom. With transvaginal ultrasound it was possible to identify and measure the endometrial thickness in eight cases. Endometrium sampling was successful in 16 of 18 described cases (89%). In 18 of 20 cases (90%) pathologic examination showed early-stage endometrioid adenocarcinoma (International Federation of Gynecology and Obstetrics stage I).

CONCLUSION

Previous endometrial ablation is not associated with the development of endometrial cancer. Diagnostic work-up is not impeded by previous endometrial ablation. In addition, endometrial cancers after endometrial ablation are not detected at an advanced stage.

Hysterectomy after Endometrial Ablation-Resection

STUDY OBJECTIVE

To evaluate the reasons for performing a hysterectomy in patients who had previously undergone endometrial ablation-resection (EA-R), after a follow-up of at least 6 years.

DESIGN

Retrospective study (Canadian Task Force classification II-3).

SETTING

University-affiliated hospital.

PATIENTS

Eighty-nine premenopausal women who underwent EA-R from February 1991 through February 2003.

INTERVENTIONS

Endometrial ablation-resection by electrocoagulation using a rollerball of the uterine fundus and tubal ostia zone, and electroresection using a cutting loop of the rest of the uterine cavity.

MEASUREMENTS AND MAIN RESULTS

During a minimum follow-up period of 6 years, hysterectomy was performed in 16 of 89 (17.97%) patients. In eight (9%) patients, hysterectomy was performed exclusively because of the failure of EA-R. The only factor that was related significantly to the increased possibility of requiring subsequent hysterectomy was the existence of myomas.

CONCLUSION

After long-term follow-up (more than 5 years), approximately one out of every five women who undergo EA-R will require a hysterectomy. The majority of these will be required during the first 2 years following EA-R. The existence of uterine myomas at the time of EA-R can be considered a risk factor for the subsequent need for hysterectomy.

Hysterectomy and endometrial ablation in New South Wales, 1981 to 1999-2000

OBJECTIVE

To examine the trends in hysterectomy in New South Wales (NSW) from 1981 to 1999-2000 and the impact of endometrial ablation.

DATA

Computerised discharge summaries from private and public hospitals for the years 1981, 1991, 1994-1995 and 1999-2000 obtained from the NSW Health Department. All records listing hysterectomy in women over the age of 20 in each period were selected and those listing endometrial ablation since 1991 were also selected. Operative procedure, diagnosis, hospital type, length of stay and demographic data were recorded. Annual figures since 1988-1989 for hysterectomy and ablation were also obtained.

FINDINGS

Initially it appeared that the introduction of endometrial ablation might reduce hysterectomy rates, but the combined rate of hysterectomy and endometrial ablation continued to rise to a peak in 1992-1993 and has declined since. The hysterectomy rate in 1999-2000 was lower than in 1981. There has been a marked shift from abdominal to vaginal hysterectomy, with an increase in laparoscopically assisted operations. Overall, the mean age at operation has been rising, although the mean age for vaginal hysterectomy has fallen. The shift to private hospitals and reduction in hospital stay have continued.

CONCLUSION

The trends are consistent with the increased use of laparoscopic and ablation techniques, improvements in hormonal contraceptive use, and better access to abortion, which have facilitated women's decisions to postpone their births and to conserve their childbearing to older ages. Further development of these techniques will have an impact on gynaecological training and practice in the next decade.

Long-term success of endometrial resection: In everyday clinical practice, personal audit is more important than the knowledge of how the majority of surgeons perform

Results of a personal audit of the long-term success of endometrial resection are used for comparison with other published data to demonstrate the importance of personal audit.