Outcomes of Women Who Underwent Hysterectomy for Persistent Cervical Dysplasia

Hysterectomy is a definitive treatment for women with persistent cervical dysplasia or high-risk human papillomavirus (HR-HPV) infections. Postoperative follow-up, including vault cytology, is crucial for detecting residual or recurrent disease. The authors aimed to evaluate the indications, surgical approach, outcomes, and adherence to post hysterectomy surveillance recommendations over a 6-year period.

A retrospective study was conducted on hysterectomies performed between January 2018 and December 2023. Of 874 hysterectomies, 53 women met the inclusion criteria of undergoing hysterectomy for current or history of cervical dysplasia. Data on patient demographics, surgical approach, complications, histopathology, and follow-up adherence were analyzed.

The mean patient age was 50 years, with a mean BMI of 30 and parity of 2. Smoking and immunosuppression were present in 36% and 15%, respectively. The mean number of prior LLETZ was 2. The majority (72%) underwent laparoscopic hysterectomy, 9% total abdominal hysterectomy, 15% vaginal hysterectomy, and 2% laparoscopic-assisted vaginal hysterectomy. Significant intraoperative complications occurred in 6%. Postoperative complications affected 21%. Residual CIN was found in 68%, with 1 case of invasive adenocarcinoma. At 6 months, 83% had test of cure vault smear, below the Irish guideline 95% target. Of these, 55% were normal, 25% had persistent HPV, and 20% had cytological abnormalities. Eight percent had vaginal intraepithelial neoplasia-2 treated with imiquimod, 1 subsequently referred for laser, and 2 managed conservatively. Vaginal intraepithelial neoplasia was present in 4%.

This study highlights the outcomes post hysterectomy for cervical dysplasia and prevalence of VaIN portraying the need for post hysterectomy surveillance.