Pacelli J, Gosset M, Rossi L, Ngo C, Delomenie M, Nos C, Lécuru F, Bats A-S
Chirurgie cancérologique gynécologique et du sein, hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France; Inserm UMR-S 747, université Paris-Descartes, 75015 Paris, France.
Chirurgie cancérologique gynécologique et du sein, hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France; Faculté de Médecine, Sorbonne Paris-Cité, université Paris-Descartes, 75006 Paris, France.
Gynecol Obstet Fertil Senol. 2019 Jun;47(6):497-503. doi: 10.1016/j.gofs.2019.04.010. Epub 2019 Apr 16.
Lynch syndrome (LS) is a hereditary predisposition to cancers, first of all, colo-rectal and endometrial cancers in women. Although recommended, gynecologic screening has never proven its benefit. Prophylactic surgery can be considered once the parental project is completed. There are few data regarding the assessment of prophylactic surgery. The objectives of our study were to evaluate the feasibility and morbidity of prophylactic hysterectomy in patients with Lynch syndrome.
This is a descriptive retrospective study of consecutive patients with LS undergoing prophylactic hysterectomy at the Georges-Pompidou European Hospital from 2002 to 2016. We collected demographic characteristics, results of preoperative assessment, intra- and postoperative data, final pathologic result as well as postoperative follow-up data.
Forty patients were included in the study, and seventeen women had a history of colon cancer surgery. All hysterectomies were performed by laparoscopy, with two cases of laparoconversion. Two intraoperative complications occurred: serosal small bowel injuries and superficial bladder injury. Two early postoperative complications occurred (a peritonitis on small bowel perforation and a peritonitis on left ureteral injury) and two late complications (vesico-vaginal fistula and adhesive small bowel obstruction). All operative specimens were benign. With a median follow-up of 28 months [5-52], no patient had peritoneal cancer.
Our study shows that prophylactic hysterectomy in Lynch syndrome should be done with caution. Per and postoperative complication rates appear to be higher than in general population, probably related to a more frequent history of colorectal cancer. However, total hysterectomy with bilateral salpingo-oophorectomy appears to be an effective strategy for preventing gynecological cancers in women with the Lynch syndrome.
林奇综合征（LS）是一种癌症遗传易感性疾病，首先是女性的结直肠癌和子宫内膜癌。尽管有推荐，但妇科筛查从未证明其益处。一旦完成生育计划，可考虑进行预防性手术。关于预防性手术评估的数据很少。我们研究的目的是评估林奇综合征患者预防性子宫切除术的可行性和发病率。
这是一项对2002年至2016年在乔治·蓬皮杜欧洲医院接受预防性子宫切除术的连续LS患者进行的描述性回顾性研究。我们收集了人口统计学特征、术前评估结果、术中和术后数据、最终病理结果以及术后随访数据。
40例患者纳入研究，17名女性有结肠癌手术史。所有子宫切除术均通过腹腔镜进行，2例中转开腹。术中发生2例并发症：浆膜层小肠损伤和膀胱浅表损伤。术后发生2例早期并发症（小肠穿孔引起的腹膜炎和左输尿管损伤引起的腹膜炎）和2例晚期并发症（膀胱阴道瘘和粘连性小肠梗阻）。所有手术标本均为良性。中位随访28个月[5 - 52个月]，无患者发生腹膜癌。
我们的研究表明，林奇综合征患者进行预防性子宫切除术应谨慎。围手术期和术后并发症发生率似乎高于普通人群，可能与结直肠癌病史更常见有关。然而，全子宫切除加双侧输卵管卵巢切除术似乎是预防林奇综合征女性妇科癌症的有效策略。
