Incidence of uterine cancer after supracervical hysterectomy

Supracervical hysterectomy (SCH), commonly performed during sacrocolpopexy, involves removal of the uterine corpus, leaving the cervix in-situ. Significant anatomic variation exists in remnant tissue, which may develop into a uterine malignancy. No prior studies have sought to describe the future risk of developing de novo uterine cancer after SCH with benign pathology. This study aims to describe the incidence rate of uterine cancer following SCH performed for benign indication.

Retrospective cohort study of patients who underwent SCH between June 2000 and December 2022 using the Premier Healthcare Database. Demographics and covariates were compared between patients who did and did not develop malignancy. Primary outcome was incidence rate of uterine cancer after benign SCH. Kaplan-Meier estimates were used to assess uterine cancer risk following SCH.

Among 25,126 benign SCHs, 92 patients (0.37%) were found to have incidental malignancy at the time of hysterectomy, and 35 (0.14%) patients subsequently developed de novo malignancy despite benign pathology at index surgery with an incidence rate of 0.44 per 1000 person-years (95% CI 0.31-0.61). Patients with uterine cancer were older (54.7 vs. 48.8 years, P<0.001) with lower rates of pelvic organ prolapse (17.3% vs. 35.7%, P<0.001) and higher rates of postmenopausal bleeding (19.7% vs. 3.0%, P<0.001), endometrial hyperplasia (11.2% vs. 1.2%, P<0.001), and cervical abnormalities (16.5% vs. 5.6%, P<0.001).

Incidence of incidental and de novo uterine cancer after benign supracervical hysterectomy are low, occurring in 0.51% of patients, and can augment counseling regarding hysterectomy approach.