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Precancerous Lesions Of The Endometrium: Uterus And Fertility Can Be Preserved

Until recently, the traditional approach to precancerous lesions of the endometrium was based on curettage (scraping), a blind and aggressive diagnostic procedure that didn’t single out focal from extended lesions.

Lacking more precise information, clinical doctors used to turn to hysterectomy, or uterus removal, which precluded future pregnancies to affected women. Hysteroscopy changed this approach, allowing to identify lesions that require a more conservative management, like with precancerous lesions of uterine cervix (or bowel).

The effectiveness of such a conservative approach - very useful in young women who plan future pregnancies – was proved by a five-years investigation carried out at the Hysteroscopy Service of the Department of Obstetrics and Gynecology at the Institute of Child Health Burlo Garofolo (ICHBG) in Trieste, Italy, directed by Professor Secondo Guaschino.

In the trial, conservative resectoscopic treatment was offered to 21 fertile women with atypical polyps (the earliest mark of endometrium cancer) wishing to preserve their uterus. Patients gave their consent to the study after being informed that international guidelines recommend hysterectomy for their pathology. Furthermore, they were told about the importance of regular hysteroscopic follow-up, since only direct observation of uterine cavity could assure their health. After the hysteroscopic polyp removal, women were subsequently monitored on a regular basis: twice a year for the first 24 months, and once a year in the next 36 months. After 5 years of follow–up, all patients were disease free. The study is actually in press in the American Journal of Obstetrics & Gynecology.

“This approach to the pathology – points out Federica Scrimin, head of the Hysteroscopy Service at Burlo Garofolo – is innovative in that it allows a moderately invasive intervention, preserving the uterus. Resectoscopic polypectomy is a simple intervention; it can be performed under day hospital conditions owing to the new instruments. Although the study is small, these results are promising and encouraged us to start a larger multicentric trial to evaluate the long-term efficacy and prognosis of hysteroscopic resection and coagulation of the base of endometrial polyps with focal atypia in fertile women.”

“Our interest in conservative management of endometrial lesions – says Professor Secondo Guaschino, Head of the Department of Obstetrics and Gynecology at ICHBG – dates back to 2000, when we offered hysteroscopic resection to 16 postmenopausal patients with atypical endometrial polyps who had cardiovascular disorders and were considered at high risk after preoperative anesthesiologic evaluation.

After 5 years of follow-up 13 patients were disease free. That study was published in the American Journal of Obstetrics & Gynecology. Now, we are fully aware that this conservative and little invasive method is the right one for women who wish to preserve their fertility and ability to have children. Our approach is in line with Burlo Garofolo’s, an Institute always caring for women’s health and well being”.

Cristina Serra | alfa
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