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Hysteroscopic endomyometrial resection may be an effective therapy in patients with atypical endometrial hyperplasia
Abstracts
evaluation, 42 (89%) of women receiving GnRH analog and 43 (96%) receiving D&C were satisfied with ablation results. During the first postoperative 12 months two women had hysterectomy and six had repeat ablation for continued symptoms. Conclusion. In general, no differences in outcomes were seen between pretreatments. Overall, results were excellent in both groups.
and histologic diagnosis of atypical hyperplasia were encountered among 2052 ablations. Preoperative endometrial biopsy indicated simple hyperplasia (3), complex atypical hyperplasia (6), and inadequate specimen (3). Seven women had postmenopausal bleeding, three had diabetes, and one each had PCOS and infertility. Atypical hyperplasia was confirmed in 10 patients after total endomyometrial resection; preoperative simple hyperplasia (3), inadequate biopsy (4), and atypical hysterplasia (3/6 with this preoperative diagnosis). Hysterectomy was offered but accepted only by three women; one with amenorrhea and pelvic pain, one with a 14-cm ovarian serous cystadenoma, and the third with a granulosa cell ovarian tumor. No residual atypical hyperplasia was found in the three hysterectomy specimens. Eight women remain amenorrheic and well 1 to 9 years after resection. An additional patient with amenorrhea died from colon cancer 7 years later. Conclusion. Resectoscopic surgery confirmed or detected atypical hyperplasia in 10 and excluded it in 2 of 12 patients with AUB and a previous diagnosis of simple atypical or inadequate specimen. Skillful resectoscopic surgery may be an altemative to hysterectomy in selected patients with atypical hyperplasia who are compliant with regular follow-up.
245. Hysteroscopic Endomyometrial Resection May Be an Effective Therapy in Patients with Atypical Endometrial Hyperplasia GA Vilos, PG Harding. University of Western Ontario, St. Joseph's Health Care, London, Ontario, Canada.
Objective. To evaluate the role of resectoscopic surgery in the diagnosis and treatment of women with AUB and typical endometrial hyperplasia. Measurements and Main Results. Twenty-seven women (average age 53.2 yrs, parity 2.4) with simple and seven (average age 48 yrs, parity 2) with complex hyperplasia had hysteroscopic endometrial ablation. Nineteen women had postmenopausal bleeding and nine were receiving HRT. Two had subsequent hysterectomies; one for pain and the other for incomplete resection due to an enlarged uterus. One patient died of heart disease. During follow-up of 1 to 8 years (mean 4 yrs) all patients remained amenorrheic with no clinical evidence of recurrent disease or progression to cancer. Conclusion. Resectoscopic surgery by experienced hysteroscopists is effective for typical endometrial hyperplasia, especially for women at high risk for medical therapy or hysterectomy. Patient surveillance is mandatory for early detection and management of recurrent disease or progression to cancer.
247. The Role of Resectoscopic Surgery in the Management of Endometrial Adenocarcinoma GA Vilos, PG Harding, J Silcox, A Sugimoto. University of Western Ontario, St. Joseph's Health Care, London, Ontario, Canada. Objective. To evaluate the diagnostic accuracy and possible therapeutic role of resectoscopic surgery in women with AUB and subsequently proved endometrial adenocarcinomas. Measurements and Main Results. Thirteen carcinomas were encountered among 2052 ablations. Preoperative biopsy was inadequate in seven, showing simple hyperplasia in two and complex hyperplasia in four. Total endomyometrial resection, including tubal ostia, was completed in eight patients (mean age 57 yrs, parity 2; group 1) and partial resection was performed in five (mean age 47 yrs, parity 2; group 2). Postmenopausal bleeding was present in six and two women, respectively. After hysterectomy, a small focus of cancer was found in only two patients in group 1; one performed 8 years ago (first case) and the other when hysterectomy was hastily completed after absorption of
246. Resectoscopic Surgery in Women with Abnormal Uterine Bleeding and Typical Endometrial Hyperplasia GA Vilos, PG Harding. University of Western Ontario, St. Joseph's Health Care, London, Ontario, Canada.
Objective. To evaluate the role of resectoscopic surgery in the diagnosis and treatment of women with AUB and atypical endometrial hyperplasia. Measurements and Main Results. Twelve women (average age 55 yrs, range 35-70 yrs) with AUB
$74
evaluation, 42 (89%) of women receiving GnRH analog and 43 (96%) receiving D&C were satisfied with ablation results. During the first postoperative 12 months two women had hysterectomy and six had repeat ablation for continued symptoms. Conclusion. In general, no differences in outcomes were seen between pretreatments. Overall, results were excellent in both groups.
and histologic diagnosis of atypical hyperplasia were encountered among 2052 ablations. Preoperative endometrial biopsy indicated simple hyperplasia (3), complex atypical hyperplasia (6), and inadequate specimen (3). Seven women had postmenopausal bleeding, three had diabetes, and one each had PCOS and infertility. Atypical hyperplasia was confirmed in 10 patients after total endomyometrial resection; preoperative simple hyperplasia (3), inadequate biopsy (4), and atypical hysterplasia (3/6 with this preoperative diagnosis). Hysterectomy was offered but accepted only by three women; one with amenorrhea and pelvic pain, one with a 14-cm ovarian serous cystadenoma, and the third with a granulosa cell ovarian tumor. No residual atypical hyperplasia was found in the three hysterectomy specimens. Eight women remain amenorrheic and well 1 to 9 years after resection. An additional patient with amenorrhea died from colon cancer 7 years later. Conclusion. Resectoscopic surgery confirmed or detected atypical hyperplasia in 10 and excluded it in 2 of 12 patients with AUB and a previous diagnosis of simple atypical or inadequate specimen. Skillful resectoscopic surgery may be an altemative to hysterectomy in selected patients with atypical hyperplasia who are compliant with regular follow-up.
245. Hysteroscopic Endomyometrial Resection May Be an Effective Therapy in Patients with Atypical Endometrial Hyperplasia GA Vilos, PG Harding. University of Western Ontario, St. Joseph's Health Care, London, Ontario, Canada.
Objective. To evaluate the role of resectoscopic surgery in the diagnosis and treatment of women with AUB and typical endometrial hyperplasia. Measurements and Main Results. Twenty-seven women (average age 53.2 yrs, parity 2.4) with simple and seven (average age 48 yrs, parity 2) with complex hyperplasia had hysteroscopic endometrial ablation. Nineteen women had postmenopausal bleeding and nine were receiving HRT. Two had subsequent hysterectomies; one for pain and the other for incomplete resection due to an enlarged uterus. One patient died of heart disease. During follow-up of 1 to 8 years (mean 4 yrs) all patients remained amenorrheic with no clinical evidence of recurrent disease or progression to cancer. Conclusion. Resectoscopic surgery by experienced hysteroscopists is effective for typical endometrial hyperplasia, especially for women at high risk for medical therapy or hysterectomy. Patient surveillance is mandatory for early detection and management of recurrent disease or progression to cancer.
247. The Role of Resectoscopic Surgery in the Management of Endometrial Adenocarcinoma GA Vilos, PG Harding, J Silcox, A Sugimoto. University of Western Ontario, St. Joseph's Health Care, London, Ontario, Canada. Objective. To evaluate the diagnostic accuracy and possible therapeutic role of resectoscopic surgery in women with AUB and subsequently proved endometrial adenocarcinomas. Measurements and Main Results. Thirteen carcinomas were encountered among 2052 ablations. Preoperative biopsy was inadequate in seven, showing simple hyperplasia in two and complex hyperplasia in four. Total endomyometrial resection, including tubal ostia, was completed in eight patients (mean age 57 yrs, parity 2; group 1) and partial resection was performed in five (mean age 47 yrs, parity 2; group 2). Postmenopausal bleeding was present in six and two women, respectively. After hysterectomy, a small focus of cancer was found in only two patients in group 1; one performed 8 years ago (first case) and the other when hysterectomy was hastily completed after absorption of
246. Resectoscopic Surgery in Women with Abnormal Uterine Bleeding and Typical Endometrial Hyperplasia GA Vilos, PG Harding. University of Western Ontario, St. Joseph's Health Care, London, Ontario, Canada.
Objective. To evaluate the role of resectoscopic surgery in the diagnosis and treatment of women with AUB and atypical endometrial hyperplasia. Measurements and Main Results. Twelve women (average age 55 yrs, range 35-70 yrs) with AUB
$74