Department of Obstetrics and Gynecology, Herlev and Gentofte University Hospital, DK-2730, Gentofte, Denmark.
Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Int Urogynecol J. 2023 Aug;34(8):1837-1842. doi: 10.1007/s00192-023-05481-w. Epub 2023 Feb 10.
The Manchester procedure is a successful operation to treat uterine prolapse. However, the influence on cervical cancer remains unknown. We hypothesized a lower risk of cervical cancer after the Manchester procedure.
We included all Danish women undergoing the Manchester procedure during 1977-2018 (N = 23,935). Women undergoing anterior colporrhaphy (N = 51,008) were included as references due to comparable health-seeking behaviors. The study cohort is as previously described. We assessed the risk of cervical cancer mortality after the Manchester procedure versus anterior colporrhaphy using cumulated incidence plots and Cox hazard regressions. We applied Fisher's exact test to compare the distribution of histological subtypes after the operations.
Generally, few women were diagnosed with cervical cancer (0.1% after Manchester procedure and 0.2% after anterior colporrhaphy). After the Manchester procedure, the risk of cervical cancer was reduced (HR 0.60 [95% CI 0.39-0.94]). Furthermore, we found a slightly reduced risk of overall death (HR 0.96 [95% 0.94-0.99]), but no association regarding death due to cervical cancer (HR 0.66 [95% 0.34-1.25]). The distribution of histological subtypes was not changed.
Women undergoing the Manchester procedure are at lower risk of being diagnosed with cervical cancer, while the risk of cancer specific mortality is unchanged compared to women undergoing anterior colporrhaphy. Based on this study, we cannot recommend that women exit ordinary screening programs for human papillomavirus/cervical dysplasia after a Manchester procedure.
曼彻斯特手术是一种成功的治疗子宫脱垂的手术。然而，其对宫颈癌的影响尚不清楚。我们假设曼彻斯特手术后宫颈癌的风险较低。
我们纳入了 1977 年至 2018 年间所有接受曼彻斯特手术的丹麦女性（n=23935）。由于健康寻求行为相似，我们纳入了接受前阴道壁修补术（n=51008）的女性作为参照。该研究队列如前所述。我们使用累积发病率图和 Cox 风险回归评估曼彻斯特手术后与前阴道壁修补术相比宫颈癌死亡的风险。我们应用 Fisher 确切检验比较手术后组织学亚型的分布。
一般来说，接受曼彻斯特手术后宫颈癌的诊断率较低（0.1%），接受前阴道壁修补术后为 0.2%。曼彻斯特手术后宫颈癌的风险降低（HR 0.60 [95% CI 0.39-0.94]）。此外，我们发现总体死亡率略有降低（HR 0.96 [95% CI 0.94-0.99]），但宫颈癌相关死亡率无关联（HR 0.66 [95% CI 0.34-1.25]）。组织学亚型的分布没有改变。
接受曼彻斯特手术的女性被诊断为宫颈癌的风险较低，而与接受前阴道壁修补术的女性相比，宫颈癌特异性死亡率没有变化。基于这项研究，我们不能建议女性在接受曼彻斯特手术后退出人乳头瘤病毒/宫颈发育不良的常规筛查计划。
