Incidental gynecologic cancers in women who underwent surgery for pelvic organ prolapse

Aims: Despite symptom inquiry and preoperative sampling are performed for endometrial, cervix and ovarian pathologies in the preoperative evaluation, it is not clear whether cancer will be detected in the surgical specimen of an asymptomatic patient for pelvic organ prolapse surgery. In our study, we aimed to investigate the incidental cancer rates in patients who underwent vaginal or abdominal surgery due to pelvic organ prolapse. Methods: In this retrospective study, all patients who underwent surgery for pelvic organ prolapse at Istanbul Training and Research Hospital between 2019 and 2023 were included in the study. Patients who had diagnosis of cancer were preoperatively excluded from the study. Preoperative transvaginal ultrasound were made for all patients using sonography by 5 MHz probe, (Voluson E8, GE Healthcare, Milwaukee, WI) or MRI. Accompanying endometrial, myometrial and adnexial pathologies were recorded. Routine endometrial thickness at preoperative evaluation was saved. Type of the surgery for pelvic organ prolapse, complications and final pathology reports were recorded. Approval for this study was obtained from İstanbul Training and Resarch Hospital Education Planning and Coordination Department (Date 13.10.2023, Decision No. 277). This study had been performed in accordance with the ethical standards described in Declaration of Helsinki. Results: 107 patients had surgery due to pelvic organ prolapse between between 2019 and 2023. Mean endometrial thickness before surgery was 4.72+-4.27 mm. After surgery, all of the hysterectomy +- salpingooferectomy specimen sent to pathology. In our study there was a statistical difference between preoperative and postoperative diagnosis of endometrial polyps as p:0.0001. Due to the fact that Pipel is more effective in postmenopausal patients, the false-negative rate of office endometrial sampling, and that the main evaluation should be endometrial sampling accompanied by hysteroscopy. We did not evaluate endometrium by hysteroscopy preoperatively, so endometrial polyps can be found incidentally. In our study there was no incidental diagnosis of cancer. Conclusion: Despite the risk of incidental cancer detection is different and controversial in the literature, it was ultimately decided to send the hysterectomy material for routine pathological examination.