Dr Polan on Perioperative Outcomes With Supracervical or Total Hysterectomy Plus Colorectal Resection

Rosa M. Polan, MD, fellow, gynecology oncology, Wayne State University, Barbara Ann Karmanos Cancer Institute, discusses key data from a comparison of perioperative outcomes with supracervical and total hysterectomy performed with concurrent colorectal resection in women.

Although retention of the cervix during hysterectomy is thought to decrease operative morbidity vs total hysterectomy, its benefit for patients who also undergo colorectal resection have been underexplored. To address this unmet need, a study of patient outcomes after total vs supracervical hysterectomy was conducted. The analysis included 5,997 patients with low pelvic anastomosis who had undergone both a hysterectomy and colorectal resection. Of these patients, 78.7% underwent supracervical hysterectomy and 21.3% underwent total hysterectomy.

Results showed that patients who underwent supracervical hysterectomy at the time of anterior colorectal resection demonstrated a reduced need for subsequent blood transfusions, a shorter hospital stay, and decreased operative time compared with total hysterectomy. However, anastomotic leak, surgical morbidity and mortality rates were similar between both groups.

Based on these data, total hysterectomy may be selected for patients who can tolerate a longer operative duration. Conversely, patients who require shorter operation time and those in whom increased risk of blood transfusion should be avoided may benefit more from a supracervical hysterectomy.

Although these findings may not have utility in clinical trials, they could improve patient counseling and better inform operative decision-making according to risk stratification in surgical settings.