Gynecologic abnormalities in surgically treated women with stage II or III rectal cancer1

Becker, Sven O; Tomacruz, Raffael; Kaufman, Howard S; Bristow, Robert E; Montz, Fredrick J

« Previous Next »Journal of the American College of Surgeons
Volume 194, Issue 3 , Pages 315-323, March 2002

Gynecologic abnormalities in surgically treated women with stage II or III rectal cancer¹

Sven O Becker, MD
- The Kelly Gynecologic Oncology Service, the Departments of Gynecology and Obstetrics, and Oncology (Becker, Tomacruz, Bristow, Montz) Baltimore, MD, USA
Raffael Tomacruz, MD
- The Kelly Gynecologic Oncology Service, the Departments of Gynecology and Obstetrics, and Oncology (Becker, Tomacruz, Bristow, Montz) Baltimore, MD, USA
Howard S Kaufman, MD (FACS)
- The Department of General Surgery (Kaufman), The Johns Hopkins Hospital and Medical Institutions, Baltimore, MD, USA
Robert E Bristow, MD
- The Kelly Gynecologic Oncology Service, the Departments of Gynecology and Obstetrics, and Oncology (Becker, Tomacruz, Bristow, Montz) Baltimore, MD, USA
Fredrick J Montz, MD, KM (FACS)
- Corresponding address: Fredrick J Montz, MD, KM, FACS, The Kelly Gynecologic Oncology Service, 600 N Wolfe Street, Phipps 248, Baltimore, MD 21287 USA
- The Kelly Gynecologic Oncology Service, the Departments of Gynecology and Obstetrics, and Oncology (Becker, Tomacruz, Bristow, Montz) Baltimore, MD, USA

Received 18 July 2001; received in revised form 8 November 2001; accepted 8 November 2001.

Abstract

BACKGROUND:

The objective of this article is to review the incidence and management of gynecologic abnormalities in women undergoing surgery for rectal cancer.

STUDY DESIGN:

We performed a retrospective chart review utilizing the Johns Hopkins Tumor Registry and Pathology database. Eighty-six female patients who underwent abdominal surgery between 1985 and 1996 for Stage II or Stage III rectal cancer were identified. Data gathered included: patient demographics, history, intraoperative findings and complications, cancer stage and histology, adjuvant treatments, and followup. Specific attention was focused on the diagnosis, management, and followup of concurrent gynecologic problems.

RESULTS:

At the time of surgery, nineteen women (22%) had previously undergone hysterectomy and bilateral salpingo-oopherectomy. Of the remaining 67 patients, 25 (37%) were found to have gynecologic abnormalities at the time of surgery, 15 (22%) underwent adnexectomy or hysterectomy or both. Forty-two women (63%) had normal internal genitalia. Of the 61 peri- and postmenopausal women, nine underwent bilateral oophorectomy for therapeutic reasons. No prophylactic oophorectomies were performed in any of the patients.

CONCLUSION:

Incidental pathologic findings necessitating gynecological procedures are common in patients undergoing surgery for rectal cancer. These findings are frequently suboptimally assessed and managed in the pre-, intra-, and postoperative periods. Colorectal surgeons operating on women with Stage II and III rectal cancer should be cognizant of the high likelihood of identifying incidental gynecologic pathology and be prepared for definitive management of the pathology.

The utilization of prophylactic oophorectomy in postmenopausal women undergoing surgery for rectal cancer is currently not optimal; preoperative discussion should address this option.